Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date <br />r <br />To: San Joaquin County <br />Department of Public Works <br />Coulogy;r ! seFHm <br />—' (Applicant Name) <br />J2ugi S MrYNRd• <br />(Mailing Address) <br />unnlo Ct2r 0.15630 <br />(City, State, Zip Code) <br />(Area Code* Telephone Number <br />(Email Address) <br />(Detailed plans may <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />//AA045S REF # <br />CR # <br />30 20 0 711120 DRIVEWAYS; <br />ekc"—AEE RD. _ <br />56Toc(MA) QUAD KS <br />TCP.1 AE2iAt/�oRK <br />5 AL eoAwrnh4x <br />qll -�ra�{c cn Erol devices mus n�e,�� n2cl.Tc.D. 54wrc�onls <br />• /t?,ri munq Lane Wld4AS z /40-0" <br />. ((/�v>L //wcc✓ dui n9 fe ak hpur5 & oe w m ro 8, oo A+h an d <br />3;ao FAA 4o (o:oc Pr -t, <br />\i =1 i U <br />construct andloprp therwise� ncroach o County Highv�y Righi-of-Wa on <br />a roxlmatel mile <br />by performing the following work (description of work): <br />Work will commence on or after 2.o 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 />��. I ,;1Y 1i' 04 <br />bignatUreolAppliCantolItIO ►�. 17:.1 :Ill <br />ZULU <br />