Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date J- OFFICE USE ONLY <br /> I <br /> To: San Joaquin County JOB# 7 <br /> �G07�- j REF# <br /> Department of Public Works APN CR# _ <br /> EXP. DATE <br /> VALID 70 F1 r�3 zo _ DRIVEWAYS: <br /> (Applicant Name) STREET �,�,,�,�,,g,� �. �9 - <br /> AREA Z.,Z>/ QUAD <br /> j(Dc% 1i is t�° '` `� u`b L.E �Jj TYPE 13�e 'go¢E <br /> (Mailing Address) FORMS <br /> 1 <br /> _ NOTES <br /> c,k t y C 1 f !'3 pa'1d — <br /> (City, State, Zip Code) - --I <br /> € C <br /> (Area Code-Telephone Number) - <br /> Sketch (Detailed plans may be submitted) -- <br /> I <br /> i <br /> I <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> side of '= ,^"s(�- ' - t�< �� <br /> ---- -------_-__.approximately <br /> of -- <br /> ----I _______ by performing the following work(description of work):<C�1 s - �l <br /> 1 <br /> _ s ' <br /> F ( <br /> {"a L>` s <br /> Work will commence on or about _ _-__- 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 accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> Sign re of Applict-Title - <br /> ------ <br /> Date <br />