Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 2 / /-7 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN OR# � <br /> EXP.DATE <br /> Ca- to 1t'fite� - r VALID - 0 DRIVEWAYS: <br /> � t(Applicant Name) V STREET <br /> AREA � G QUAD <br /> � TYPE <br /> (Mailing Addre s) FORMS <br /> , <br /> NOTES <br /> S!l-hJ fl-ANCt 5 co_ <br /> (City,State,Zip Code) <br /> -733- qg^ 3 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may <br /> i <br /> f <br /> i <br /> I <br /> 3 <br /> I <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County High Right-of-Way on <br /> the 6-03 a1__�NB klslde of C?'¢ .! f tad;_ 9:0� _approx teiy 4_. >. .__... <br /> , performing the follov�in g work escriptfon of work) <br /> S�<>A<n 4 , 6t,ra{l t r r- ► y a—,ier A,1~ 11 N21 t 4-"Ali c>M <br /> s C-12s:Jnl r t� 4tt� i'► C �+rt�� i ( rntZ <br /> �_ 'f`,4C.4.._1AI 5 A-1t 414 <br /> G -V -— ---- <br /> Work will commence on or about_ [f__for approximately ��1 G5 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 /> described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> i <br /> igna a of A 'licant-Title Date <br /> EMB-YY "PM Mf]t. ,If PWMTAPPUGTKN DOC jmI <br />