Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> _ r <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# ows, REF# <br /> Department of Public Works APN CR# <br /> ZA� EXP.DATE ( �(- .01 b <br /> G N,�,� f[�' t}Nr � �,"e VALID - U TO --1- 20 t6 DRIVEWAYS: <br /> (Applicant Name) STREET P <br /> x <br /> et/ L;bAJ AREA QUAD <br /> :TYPE <br /> (Mailing Address) FORMSAJIA <br /> NOTES <br /> (Ci ,State,Zip Code) <br /> (Ar ode- lepho a Number) <br /> Zo "?S" o3S <br /> Sketch(Detailed plans may be s ibmitted) <br /> The undersigned hereby applies kr permission to ex te,construct and/or otherwise encroach County Hi �ht-of. y on <br /> the t9-f.6 _ side of 0 AJ r-A approximately <br /> of ��- Sn mile rf <br /> by performing the following work escriptior�of work): <br /> Work will commence on or about_ <br /> for approximately <br /> days. <br /> r,1.- wed,�erfify 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 c7cord with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> ;i-V A AA,1,r <br /> eican -Title 15- 3 /O <br /> f_:IPU&SV.NMASTE PSiE, OACHMENT PERM,TAPPl1CAT10N.pOC(pi/�) <br />