Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ` OFFICE USE ONLY <br /> To: San Joaquin County JOB# %Z7/'3 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE d /� <br /> % VALID 0 D Z DRIVEWAYS: <br /> (Applicant Name) J STREET C ry/ Oi�'ES��'�-D• <br /> AREA QUAD <br /> 7 TYPE -L ote--s 1 130 2ES <br /> (Mair Address) FORMS5 <br /> 0 NOTES <br /> �. <br /> (City,State,Zip Co <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans maybe submitted) * &9600 <br /> �. A-tt c�� �� �� LID D-P—k <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highw Right-of-Way on <br /> the side of El— f��DIP n 'ece sryfti2Iapproximately -71;r fe mile 1;i <br /> of ?—ir,-ti-4 24/ n r� P e r� by performing the following work(description of work): <br /> r� C®nylvc t�r)gg- /q6" 1-n l'��r,fzo 0( s) T lCAlCn eOX-Auil, <br /> R. r rn r tt-�rra_fz o-�s i I ) ,2f- ,/m [ ne k L tib,e64 0 <br /> Work will commence on or about for approximately 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 /> Signature of pp icant-Title Defte <br /> E IPU&SV WKWASTER.PSIENCROACHMENT PERMIT APPLICATION DOC (01108) <br />