Laserfiche WebLink
09!111'2008 11: 30 209-848-0161 MOZINGO CONSTRUCTION PAGE 02/04 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT, <br /> Date �j.r�( Ii ZOcs's OFFICE USE ONLY <br /> To- San Joaquin County JOB# REF# <br /> Department of Public Works APN CR* <br /> A EXP.DATE -D,f•t!$ <br /> ,Y`pZ iG ra_v' f` r ti VALID f!/2-QS TO /D•/-0!J3 _ DRIVEWAYS: <br /> (Applicant Name) STREET „p��o <br /> AREA QUAD " <br /> TYPE rlflG ,I�� . <br /> (Mailing Address) FORMS wuJ3 ,GZ <br /> n NOTES <br /> (City,State,Zip Code) <br /> (Area Code"Telephone Number) <br /> Sketch(Detailed plans may be submitted) 1 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of approximately a, rs<ccfila� <br /> of LQ DDr i rL. by performing the following work(description of work): <br /> va ty 10a 0y) Z r q in I-t 1 i Yt F <br /> Work will commence on or about S for approximately 2 days. <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner 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 /> a.,. - ;. i/, arm <br /> Signature of Applicant-Tt a Date <br /> F,1R;195:'.6Vr,1h+n$TC?,C$lfN('ROACFNAENT PERMffM1M'I.ICA710N.ROC 171.bA) <br />