Laserfiche WebLink
Q5-(t bt2 e,Z <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PR NT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# <br /> Department of Public Works %/OIJU 7 REF# <br /> APN -� CR# <br /> ��/G' EXP. DATE <br /> G/� 1�ti VALID TO �/ DRIVEWAYS: <br /> (Applicant Name) STREET �r�p <br /> 2S G 41 4/t, AREA QUAD --A , <br /> 2.4 c�R z-� <br /> yMalling Address) TYPEFORMS <br /> w� <br /> /VI DNOTES <br /> PtY,State,Zip C e) <br /> (Area Code-Telephone Number) _ <br /> Sketch(Detailed pians may be submitted) <br /> 5RW. 14T-r� <br /> I <br /> The undersigned hereby applies for <br /> the ` of' permission to excavate,construct and/or otherwise encroach on County HighwayRight-of-Way <br /> No__ Rside j <br /> of � approximately 'Z.S on <br /> feeUmile the <br /> by performing the following work(description of work): <br /> L 'T-6) 3-1qo►-.4. AT- <br /> �,� rZ7" aoRIN6 �f ZFf <br /> f�FK4s� .��� ,q- A✓�.€" 'Ttt&' w6 „� � FIBS h� i F tT iS OF�,�,� <br /> 8g A�?✓si.�.�.�. Nom' Sil�".�.�.- _.., <br /> oD !�/ �L_.�►waa17 ,gyE-�/ve� .4 C <br /> OS /Oir/, GG9ST+ �S D5f/d F To TN�e�" <br /> Work will commence on or about L� w '` <br /> � �" bT`" f'.4TG <br /> for approximately •-L <br /> ►, the undersigned,mortify that I am the owner of the res�tive ro days. <br /> work described abova in accordance with the rules and p ��'or am qualified to represent the owner and agree to do the <br /> regulations of San Joaquin County and subject to inspection and approval. <br /> Signatureof Applicant•Title � �66'1z <br /> `WSSVWK"STER.PS*KROACRM!JTPERWAPpL,CATIONOC.DO,M) @ <br />