Laserfiche WebLink
rv1a' v vv vc',T Q 110Iv1 ,NY. I cvv v�T-r ry <br /> N , <br /> 63/110/2088 10: 12 2094689324 SJUu rtNmllS rant V A I U <br /> r <br /> APPLICATION FOR ENCROAMMM PERMIT <br /> PLN _ P-RX T <br /> Date ' 2- ' y% orricE II8E ON1,Y <br /> To: SRn Joaquin County J_On ,# x REF # <br /> Department of public works APN Ck # <br /> EXP. DATE X <br /> VVI IDX TO x DRIVE?0AX9: <br /> (Applicant Name) T— STREET r <br /> AREA x RVAD X +� — <br /> V� TYPE <br /> rr (Mailing Addreee) FORMS �C <br /> NOTE <br /> {City, State. Zip Codef <br /> (Ares Code -. Telephone Dumber) <br /> (Z��� 3'9") _ 4 <br /> sketch (betatl ed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate, construct and/ox <br /> otherwise encroach on County Highway Right-of-Way on the aid0 of <br /> approximately feet/mile, <br /> of by 'perfzorming the <br /> following work (descriptioriof work) : <br /> Work will commence on or about n� ZTLZ 7iC� for approximately <br /> 1 rn <br /> days, a M. /U: // <br /> 2, the undersigned oertify that I an the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> acc ce with the rules, regulations of San Joaquin County and subject to <br /> zn ect .an and approval. <br /> i urs of Applicant - Title Date <br />