Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> ,PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> cl� DRIVEWAYS: <br /> VALID 2—! 0 4z; /�Z- <br /> (Applicant Name) STREET <br /> & <br /> 4 I�W'ZrZ5�WAQ Zk/ <br /> 1.1 All I <br /> TYPE / <br /> —___- <br /> (Mailing Address) FORMS <br /> NOTES <br /> -K vs e4 <br /> TCity,State,Zip Code) <br /> 4 <br /> Q, <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> I 7F <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Hig, a§R!ig1t-o!-Wayon <br /> the -side of approximately fee 4 <br /> -2 by performing the following work( ascription of work): <br /> escrintic <br /> of k I <br /> t4_0( <br /> Work will commence on or about for approximately days. <br /> 1,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 /> 17 <br /> Ah <br /> Signature of Applicant-11ti; Date <br /> Tj3 SVW'(W.ASTF.R PTiNCROACH-A EV P-ERk.-I A P.' !C AT tON'31-^ 10!0) <br /> 900121 ISM Dialli WGIM00A 9Z9969C60ZT XVd £0:ST 9T09/CZ/V0 <br />