Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date (�� / �� f OFFICE USE ONLY <br /> y e <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> ^� EXP.DATE <br /> l nC r VALID Z 0 / l2 DRIVEWAYS: <br /> (Applicant Name) STREET ;e,,cf <br /> AREA 5V-aQ AD �fE <br /> 3 b ) TYPE -726vej-f Z6w X&z4!5 <br /> Wafffid Address) FORMS s�G✓rtq �-ZS' <br /> ' <br /> r 0J) NOTES <br /> �� �1� <br /> (City, State,Z p Code) <br /> LL -714 -14 r C <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permissito excava ,constr ct and/or otherwise encroach on County HighX <br /> ight-of-Way on <br /> the 5�� (� side of approximately a:7g ile�J� <br /> of by performing the following work(description of work): <br /> 04 a Ini <br /> nm <br /> r > _ P - <br /> Work will commence on or about 11,45:1 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 o pplicant-Title ' Date i <br /> E IPUB-SV.WKWIASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />