Laserfiche WebLink
APPUCATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date Z 99 ho 12. OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> ��/ICAST� VALID Z 0 DRIVEWAYS: <br /> (Applicant Name) STREET <br /> pp� AREA D�i�.6QUAD <br /> 41-70 ELOER UEF14 N/. TYPE pLEJ ,QF <br /> (Mailing Address) FORMS 2-51 <br /> SkRAME Wo CA '9!5'5'Z44 NOTES <br /> (City,State,Zip Code) V <br /> 650- <br /> 6�0 - 0530 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> NF-eD y?,6' Or 130PE -V TPS ALL 21' HDPE 60NtV 1" <br /> BeTW F_E N A fOL- AND FRENCH CAMP <br /> ELF-M F= - AKY, <br /> �N { E t4TH Si-. FRENCH CAMS It f 07,502 <br /> The undersigned hereby applies for permissio to excavate,construct and/or otherwise encroach on Copnty High Right-of-Way on <br /> the 50Q QMM side of EL.M Gf ifd WEEN <br /> Of F. RZE-Wal CAW RD A; 4TH ST. by performing the following work( ascription of work): <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 /> hi zolZ <br /> �e of ApWpli iNe Date <br /> E9U6W P@d/fAPRIf.AipMDOC p60y <br />