Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date I '- OFFICE USE ONLY <br /> To: San Joaquin County JOB# fj' (,$ ,-�` REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> (`> VALIDT /S dj DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA QUAD A <br /> TYPE �t _ <br /> (Mailing Address) FORMS <br /> r z 1 NOTES <br /> (City, 9tatie,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> { <br /> The unde)rsigr�ed hereby applies fr�r permission to excav te,construct and/or otherwise encroach on County High Right-of-W on <br /> the <br /> w side of '>�' !! ? ' .- approximately I'a ti eetl rile <br /> Ll I / Ad? t b erformin the followin work descri tion of ork : <br /> rem _� 2- y p 9 9 ( P ) <br /> Work will commence on or about_n,-ltrh L j o for approximately 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 /> t <br /> , <br /> ilik'A <br /> ature of A p i a t-Title Yate <br /> EWU&S�WKWASTER PSIENCROACHMENT PERMIT APPLICATION DOC (01108) <br />