Laserfiche WebLink
APPLICATION POR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date LC - 4 L i C, <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB # '110071--21 <br /> Department of Public WorksAPN REF # <br /> CR. # <br /> -1 <br /> EXP. DATE <br /> VALID \2. 2'i o T t 1i DRIVEWAYS: <br /> (Applicant Name) STREET <br /> Gll1! t�rti1L� - AREA ,nd _ QUAD NE <br /> TYPE ,. <br /> (Mailing Address) FORMS 'S5 uo <br /> r�c <br /> t t'�`�c3- NOTE C� <br /> (City, State, Zip Code) <br /> 40 <br /> (Area Code - Telephone Number) <br /> Fketch,. etailed plans may be submitted) <br /> Li � AITAUAE-0 sKE-V C <br /> ,,� 14 - 4 , r► <br /> The undersigned hereby applies for permission to excavate; construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the SDo;�,-1 <br /> C.o<Y1ST0CK RI-3 _- <br /> of <br /> of J AG1t -lU it r 9-b , -- approximately I lots feet/mike <br /> following work (description of work) : <br /> by performing the <br /> tKtSi iiltr t'ascl2. ;� �E�1CFl '+ ��acE A- i.a�; „ <br /> i �Ki.1c> e'. , +,.K� stunt r,.a k�kc `vc <br /> y:iSC>L i� z t S � j t,a c2.K 0 S (Z u, tU 20 r i i� F� 1 <br /> i C L 7o A C S i 1t cot A .p e !{ r✓� i StY� 4'c+ 531 ] <br /> Ai-k, a,�c k b rel S �flu� <br /> Work will commence on or about <br /> "1 - X010 <br /> ��- L days. for approximately <br /> I, the undersigned certify that I am the owner of the respective property, _r am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval. <br /> Signature of Applicant - Title ` 1 �� <br /> Date <br />