Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date !O --2-0 - /o OFFICE USE ONLY <br /> - To: San Joaquin County JOB# Z36e 19 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID O // TO DRIVEWAYS: <br /> (Applicant Name) STREET A <br /> AREA QUAD <br /> Z-0 1 Cq L- rv2�1 i 6 S7. fJ /2�C� TYPE Gr!/Q/�liL2YXJ/,meq Am, -o G'✓.�' +SIJ <br /> (Mailing Address) FORMS �'t�> zf <br /> �S A,Jf=�ia cE S Lc� C �/ /( ( NOTES <br /> (City,State,Zip Code) <br /> 4 I S -z- U <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> C <br /> So 3 rv(c-H'�- L A tJ S <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the c--,5' sideof LAM61e7rLs 2060 approximately Z700 feet/nr W 5i-427,r-,,ir4 <br /> .� -rr t� �(fv�.�rtf S�• rt�25t���� i+���tiNy SJ�nt by performin the followin work(description of work): <br /> IZof40w�-( wTao��uVQ r11n(c�uoraua J i 4 �o At-L <br /> /t SSOC'14tQn Wd2V /}2tuV.T �� ��$G&T/dto w,*4,,J 4r SJgM�t7 PLArJS A J0 <br /> eN 7rt�. �A f T?t �F� �S l';'✓/ff-7 E� /+TTr9 c�f� <br /> Work will commence on or about for approximately 7k2A 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 /> J-47-1 - o - Z - /0 <br /> Signature of Applicant-Title Date <br /> E:1PUB-SVWKMSTER.PSIENCROACHMENTPERMTAPPLICATION.DOC (01108) <br />