Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 9/11/08 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 1/L.�l REF# _ <br /> Department of Public Works APN CR# <br /> EXP.DATE �•/ D� <br /> Oakdale Trri chat i on district VALID TO „�'•/,.5r'O$ _ DRIVEWAYS: <br /> (Applicant Name) STREETaF J , <br /> AREA QUAD <br /> 1205 East F. St TYPE <br /> (Mailing Address) FORMS �— <br /> Oakdale, Ca. 95361 NOTES — <br /> (City,State,Zip Code) <br /> 209-847-0341 <br /> (Area Code-Telephone Number) — <br /> Sketch(Detailed plans may be submitted) <br /> See Attached Map <br /> iAQ"(S <br /> ` a3LfL — 1 SS LZ <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 Droge Rd- approximately 1600' feet/miIJ41 <br /> -W <br /> Of Mari mga Rd by performing the following work(description of work): <br /> RemQyf-, and with n <br /> Ce pipe crossing e 100# 15 inch pyepirp Backfill with either <br /> two sack slurry or 3/4 A/B conmacted to 90% <br /> Work will commence on or about 11/1/2008 for approximately izu 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 /> Sig �reof -e'`--` <br /> Date <br /> E%PUMV.WKI)AgyTERPSIENCROACHWNTPERWTAPPLICATON.DOC (01M) <br />