Laserfiche WebLink
2095781974 M St.,Modesto Ca '66—_' 3(Le( 02:15:39 p.m. 10-01-2008 2/3 <br /> APPLICATION FOR ENCROACEDESNT PERMIT <br /> PLEASE PRINT: <br /> Date Y.'/'f/ OFFICE USE ONLY <br /> To: San Joaquin County Jag #�' r-° REF # <br /> Department of Public Works ApN CR # <br /> EXP. DATE 11-1— O 1 <br /> d VALID 10-,3- TO 1 1"1-O t DRIVEWAYS: <br /> (Applicant Name) STREET 1Jr.JS ,1C yam- <br /> �3a� T wu 1pd AREA�A&A bkiI- <br /> E <br /> (Mailing <br /> Address) FORMS I.V <br /> NOTE <br /> (City, State, Zip Code) <br /> 5qj <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> - <br /> The undersigned hereby applies for permission to excavate, construct `and/or <br /> otherwise encroach on CountyRighway -night-of-Way on the <br /> &WLt approximatel ZZ` side of of t D) 2� e le <br /> by performing the <br /> followin work {descri tion of work) : �L <br /> Work wil commence on or about <br /> for approximately <br /> days. <br /> 1, 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 andapproval. <br /> �S; atof Applican - Title <br /> Date <br /> NhS:'6A,PS\P88SC7IDL {6/00) <br />