Laserfiche WebLink
PLEASE PRINT: APPLICATION FOR ENCROACHMENT PERMIT <br /> Date <br /> To: San Joaquin County OFFICE USE ONLY <br /> Department of Public Works JOB# lftVsf 7 REF# <br /> APN CR# <br /> Ut. Arn Lo V S &I m+i't�- EXP.DATE 1,0.1. <br /> (Applicant Name VALID <br /> P STREET H TO I •I.c� DRIVEWAYS: <br /> AREA — qc� QUAD Std <br /> (Mailing Address) TYPE --------— <br /> FORMS .I <br /> NOTES <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on Count <br /> the der St side of C�r <br /> of nC — 1��� 2tti,�;P a y Highway Right-of-Way on <br /> approximately 3 0 feet/%4 <br /> I Citi ri by performing the following work(description of work): <br /> i2av <br /> V 2 2 C <br /> 61, <br /> C L` <br /> Work will commence on or about <br /> for approximately_ <br /> I, the undersigned, certify that I am the owner of the respective property, or am qualified to represent the o days. <br /> caner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signature of Applicant-Title —s ")--� c,L, <br /> E.IPUB-SV.WKIMASTER PS�EN"ACHMENT PERMI I APPLICATION Date <br /> .DOC (Ui/08) <br />