Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7, 3 REF# <br /> Department of Public Works APN CR# <br /> 1.4 VALID r' A - ------— <br /> EXP.DATE � <br /> (Applicant Name) STREET ° TO 7��-�-��' DRIVEWAYS: <br /> AREA ~�r QUA C1 ` --- _ ------ <br /> QUAD � <br /> TYPE CG'Wo e.� <br /> 1� -"- --- --- <br /> (M ddress) FORMS <br /> NOTES <br /> (City,State,tate,Zip Code) ---^- -- - --�-- —-- <br /> (Area Code-Telephone Number) -------- <br /> Sketch(Detailed plans may be submitted) <br /> The undersign2d hereby applies ermi si n toe v te,const and/or otherwise encroa County Highway Right-of-Way on <br /> the_. .4' — sidepf approximately <br /> of __ fe ile <br /> ._- <br /> — -- ---------,by performing the following work(description of <br /> Work will commence on or about -- - ----- <br /> for approximately--- - - <br /> —-- ---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 accord ce with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Si ature of App icant - le 6 Date <br /> r'1:3.'./✓RJA.i;iERJSFNr'✓-r,.:.r rl1ENT Yf F:I Hof:i�ciryit�:_ ,,:5; <br />