Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 2 �� �3 <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# '?, •d REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE j ) <br /> I�-- VALID ♦ 0 DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA 'r'??lG1G,7'7�1/QUAD � <br /> SSSS .O(tV¢� TYPE <br /> (Mailing Address) FORMS 2 <br /> NOTES <br /> f:�'Q c K-o Cdr `Y 312-1 <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> -Z-.�-� Z-6 6 :tL- 'a9 t-72_774 3 V D Cav� Rek S--6�'4-o tJ <br /> VRI-D �j`.u-P`'`Le, cs,�g`�'x I tag`' C-auc r Q -- <br /> `� rJ Z)t R.:7r A4?-E A- _ se-e `)r&uJ " -�b K <br /> Cm I f-D c_._-(- c p e_ P-tc a�i i�&S <br /> .D" t Ckr L S4?>d-V -a Z A-- F3( _-72-g-01(o d <br /> The undersigned hereby applies fob Ypermission to excavate,construct and/or otherwise encroach on County Highwa Right-of-Way on <br /> the.fit —side of approximately approximate/ �00 <br /> Y e mile f 4�' <br /> of by performing the following work description of work): <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 /> l3 <br /> ignature of Ap icant-Title Date <br /> E PU6SV.VYN`MMTER.PSIENCROACHMENTPERMITAPPLICATION.DOC (01M) <br />