Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date `� OFFICE! USE ONLY <br /> NLY <br /> TO: San Joaquin Counts JOB # i d$oZ-Cp REF # <br /> Department of :Public Works APN CR # <br /> EXp. DATE .A-1s.06 <br /> ' VALID jO TO 4.115-OS DRIVEWAYS: <br /> (Applicant Name) STREET LoWU fYiW*1ftAb <br /> D AREA QUAD WAJ <br /> 40 zzlesT Z,/, TYPE AXSKKH 4-1&5=J5 <br /> (Mailing Address) ,p FORMS <br /> NOTE � <br /> (City, State, Zip Code) <br /> e <br /> (Area/Code - T`selgephone er) <br /> PA CUS <br /> Sketch (Detailed plans may be submitted) <br /> TRAFFIC CONTROL PLAN <br /> SHAL_ BE AS PER <br /> CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> The undersigned hereby applies for permission to .excavate, construct and/or <br /> otherwise-encroach o County Highway Right-of-Way o -the 25"j- side.of <br /> �vtv/� .S�Cr4/yle 1�O approximately / mil <br /> of by pe-r€ i g the <br /> fol owing wor description of work) : <br /> o,ei v k rn Orfjzoew a f® <br /> Work will commence on. or about for approximately <br /> 1Z® days. <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval. <br /> Signature of Applicant - Title / Dai <br /> MASTRR.PS\?BSS®L (6/00) - <br /> I� <br />