Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 9 z�3/-?p 13 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 1160015 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 1119113 <br /> COMCIA-ST C.ABI� <br /> VALID1 T6 14KL-; DRIVEWAYS: <br /> (Applicant Name) STREET / <br /> AREA 4r5ar.9,41 QUAD <br /> foso5 M ds�tanlTE[i; Pg TYPE �u- H46s(2) sir w .t le <br /> (Mailing Address) FORMS SST tv) -A-lie.4 6.1i�/fly <br /> NOTES <br /> SEDctLIDIJ t:A °15210 <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> �G-HE.b �clTcpll PLAN(-' <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the �•As A side of G r i 6-1(l 6y p t-oc c:. approximately O rfeetlmild soul <br /> Of CA L+i D U rl-- W O\J ,by performing the following work(description of work): <br /> S 5 N JCTI U LAN 4�T '' 3► 200 tv1R P <br /> T-Q,o _taidISIWGr 6,A.1,V. VAULT LQ -64 <br /> Mb OW 6328 MQ7S%V PL QM4 I140' .p <br /> txisTlnlfiE g Iv--6e vRULT. :--m&TAu- 20 eotoDoIT K4 R mot,--nPr.F— Sibtu*%AL uACGS . IPDT- <br /> < Cx R D 5 <br /> 'fomc1 Rote- LEn)GTlrr lyor <br /> Work will commence on or about for appmxima* days. <br /> 1,the undersigned,certify that 1 am the owner of the respective property,or am gt0led to represent the owner and agree to do the <br /> work described above in wcordance with the rules and regulations of San Joaquin County and subject to Mpection and approval. <br /> Q rr c�oa�t ,rOR. C?�231 W <br /> of AWkwa-Title T Dow <br />