Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date Join Mary L+' 201 OFFICE USE ONLY <br /> F#B# f/L��'�J' RE <br /> To: San Joaquin County JORE# <br /> Department of Public Works APN <br /> EXP.DATE 2 I !3 <br /> VALID Z / I3 DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA 10dI pTdAl QUAD /V <br /> TYPE E <br /> (Mailing Address) FORMS <br /> NOTES <br /> Sacrgvyitn+-01 CA <br /> (City, State,Zip Code) <br /> °I l to • 3(o b- (� C I <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Sul A+H dh to P I a n..S - <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County HigMeeile.,'5W7;V ight-of-Way on <br /> approximately 220 . <br /> the 4,4� side of e w Ito Road pp Y <br /> of San Toa u11 SQ��a"^�-'' a e )�rnn a R;vzr , by performing the following work(description of work): <br /> coo CA n-V\l i r<t <br /> Drill q W" bob n USIn mud f0+u� kna10 p ' WYA to o+ccr)i ca <br /> {- n nA o ►� i born w I� C-ee n <br /> Work will commence on or about for approximately �' dZas,-Iua work shoutd only . 4A <br /> �"2 <br /> (Ac 1 a,►ys <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. San-T <br /> Cowl <br /> - `- S+Off �nfironmer►"�t 01-p�--2013 <br /> Signature of Applicant-Title �n9;n-et r Date <br /> E:1PUS-WWKIMASTER.PSIENCROACHMENTPERMIT APPLICATION.DOC (01108) <br />