Laserfiche WebLink
209527381 8-^iie�ngir.f�rr-'� 59:2' a.m- _-02-2010 2!2 <br /> r <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ! 1 - �Q_�O _ OFFICE USE ONLY —� <br /> To: San Joaquin County JOB# 13 oa-2q_ REF# 'J <br /> Department of Public Works APN CR# -- -- <br /> m j EXP.DATE it <br /> VALID 13 d 0d- <br /> AREA <br /> i i+ DRIVEWAYS: <br /> (Applicant Name) STREET ' <br /> 7 ( QUAD <br /> C �t1t„�1 I TYPE f e nc 'A <br /> (M ill g Address) i FORMS <br /> '— NOTES <br /> (City,Stdte,Zip Code) _ <br /> 1 <br /> {Area Code-Telephone Number} _ <br /> j Sketch(Detailed plans maybe submitted) -� <br /> a <br /> l <br /> I <br /> i <br /> The undersigned hereby applies for permission to exc vate,construct and/or otherwise encroach on County Highw Right-of-Way on <br /> the ti OQ_ _side of E approximately_ _ PP Y fee ile <br /> Of��tc, , _ <br /> by performing the following work(description of work}: <br /> - -- <br /> Work will commence on or abort _forapproximately <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 /> r <br /> �q� <br /> Sig re a Date <br /> •:.:a!:Y.1n,.'.1 ::G,,h:n_ACrrM.i V'.rr hA',iI%.PP'..:,A CA <br />