Laserfiche WebLink
I <br /> I <br /> ' ` I <br /> I <br /> j <br /> APPLICATI013' FOR ENCROACEi�IEItiTT PERMIT <br /> PLEASE PRINT: <br /> Date CA OFFICE.. USE ONLY f <br /> To:- r r County JOB a 730652,`AD REF 4 <br /> T.,. San Jia juin � <br /> Department of public Works PpN CR <br /> EXP. DPS d /S Ili <br /> VALID 1 12, -O n DRIVEWAYS: <br /> (Applicant Name) STREET <br /> / ! AREA QUAD *. <br /> `� �7'cii�f'?ibt-� V q TYPE <br /> (2dai1__n- P_dd.:es(s�) y T FORMS LtJ 'Z <br /> C�o'yl GlrT ll v/ 7 `7 d' v NOTE <br /> (City, State, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans maybe submitted) TRAFFIC CONTROL PLAN <br /> �.:�� i►�-� G�e� • SHALL BE AS PER <br /> f a CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> The undersigned hereby applies for permission to excavateconstruct a-nd/or <br /> Soy side de of <br /> otherwise enc c-cy h on County Highway Right-of-Wa_i on `he <br /> approximateell 5� feet mile <br /> &VJof + W C_ b,` performing the <br /> =tnsfa `�' " a-S n1a h Fr~@:5 6) W <br /> followiig work. (des ription of work) : '�o S N tde <br /> a s n !d �S u) -in" t �� a �) -c, <br /> ¢� oe� a-F:a-v� a F C•- - i d <br /> r <br /> y <br /> Se <br /> fo-r approxlmatellY <br /> Work will commence on or abou <br /> " days <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the ruZes, regula` •oris of San Joaquin .County and subject to <br /> inspection and a roval <br /> r' c <br /> c Of --•--YL�'i'.L it - ate.t12 RETURN•PERL4U1TS. <br /> TO. <br /> MFSTcE S'•,FEESC�D!. (n/CO) JOB PROCESSM DESK-BLD <br /> 1 <br /> 4040 u <br /> STOCKTON, CA 95204 <br /> 1 <br />