Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date j 7 zo// <br /> OFFICE USE ONLY <br /> To: San Joaquin County FJOB REF# <br /> Department of Public Works APN <br /> CR# <br /> EXP. DATE <br /> LID TO <br /> (Applicant Name) STREET DRIVEWAYS: <br /> AREA Jl� <br /> TYPE ,P� / Ali-oy�i �(?f� <br /> (Mailing Address) FORMS <br /> NOTES <br /> (City, State,Zip Code) <br /> (Area Code•Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> 5z <br /> theThe un ersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Right-of-Way on <br /> Of aST� side of.. �� approximately GY> e �-- <br /> _ by performing the following work description of <br /> oC�E�,�iTlo�t/ Jr! it/D �D <br /> 1 CD�/sY'llGTian/ACCEsS 1�F �Iy f✓� ,e rtl �' <br /> 1!•'9d. F-��'T/ir/ CrL DESS <br /> Work will commence on or about Ito 1 oil <br /> for approximately 46, 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 /> JS�i —hature of Applicant-Title <br /> Date <br /> E1PUB-SVWMMASTER.PSTNCROACHMENT PERMIT APPLICATION DOC (G 14,8) <br />