Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ` ((f (ll Q <br /> OFFICS USE ONLY <br /> To : San Joaquin County <br /> Department of Public works JOB ' REF # <br /> APN <br /> ,� CR- #--- <br /> l�4 T �-r /o T)' L'�f,✓T�i,�,f EXP. DATE - <br /> (Applicant Name) VALID I % {F TO3 S (� <br /> STREET Yt. DRIVEWAYS: <br /> AREA QUAD * -------- <br /> (Mailing Address) TYPE -3--te. Har�S -----_ <br /> _� FORMS SJ <br /> Lir` v/(.l /. > �f -1 NOTE <br /> (City, State, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for p <br /> otherwise encroach on Count permission to excavate, construct and/or <br /> y Highway Right-of-Way on the <br /> approximately /00T—�0side of <br /> --__ <br /> of /Z16Ee <br /> following work (description of work) : , A�j Tv�%1."t &tf� `: <br /> OOk L- Al'f'�Qu"X [ 'T k��s, • by performing the <br /> PL�T,fKX ?fJ cel ". rZ� iXF0J /'fCl7 tCS. e° / <br /> HuCJ C.C(STfrf/ c> -T x i TG <br /> ` Z�fPR�C 'JG R �°RoTz!c7rvl✓ _ ��}' -T. . - <br /> Wcrk will commence on or about <br /> � Fit SU,(F,b+Ctc' <br /> v l��U �" 2c of W`�L gf KES 'tom Fv GF tTTTE� <br /> days. for approximately <br /> r 'che :: dersi-aned erLify -,hat <br /> qual f i d t� r _ a = am the civ=-er ^f t. e- _ <br /> Yprese: L`<e e r ectiz <br /> rdance with the rub�S regulations agree <br /> o do the work -described abc-7y c� am <br /> o Sar. T d abc- in <br /> i::srection and appro,.ai. Joaquin County and sub; c <br /> / J e t L;. <br /> Signature of � `� <br /> pplicant - Title <br /> 4• ._ C <br /> ate <br />