Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> DLEASE PRINT: <br /> Date f�" OFFICE USE ONLY <br /> To: San Joaquin County JOB# lIQ REF# <br /> Department of Public Works APN CR# <br /> P <br /> EXP.DATE o <br /> ./"0 e7v- eTtt5 (fWa"�kw sc 6w atc24 VALID jZ � T DRIVEWAYS: <br /> (Applicant Name) STREET ,--X" <br /> 'C7 D L/.-•0ey.,-PC-n:2,zs jr 0, AREA GZ QUAD hg <br /> TYPE -reA fpi 52 l�Z 1 t <br /> (Mailing ddress) FORMS �..----- <br /> NOTES <br /> L i �jo&-,'vj GA-q s z3(, <br /> (City, State,Zip Code) <br /> I-07-3"1Ifco x 2u -7 �ZF� -� <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> K 15 <br /> he undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> ie t3an-j— soe-of 6,44!3 o r Pao A,r ,-'j- approximately feeYmile <br /> by performing the following work(description,of work): <br /> Bosj0-lew S?' 4- Of tGt S7' 01-x- QtZgf 6c=W 57. Z90-! <br /> F�2-v�.� 5:y© y�•�-, $:3r=� �+�r ��2 �Lio,���-c.��3.2•s��'70� <br /> pork will commence on or about /372 b 7 for approximately z days. <br /> 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 /> ork described above in accordance with the rules and regulations of San Joaquin County and subiect to inspection and approval <br /> Signature of Applicant-Title Date <br /> ORMS L TEIAPLATESkENCROAC,4NENT PERMIT APPLICATION doc 10091 <br />