Laserfiche WebLink
APPUGAACM FOR ENCROACHMENT PEWIT <br />PLEASE PRINT - <br />Data �'' W) J -1 � C> OFFIGE USE'OW <br />To; ganJoaquin Gouniy <br />Departaientof Pub1faWorks <br />CA i_!r'C��/�i� �IV�I�� tfC0fQL <br />- pp (�Pp[i�ang�i�u�ie3 <br />(rda[f 11gAd.dress) <br />(C$6.Ns �d t 7, Zips CDS 0) <br />(Nea Cads -Telephone Number) <br />skefch (Detailed pans may basubmitted) <br />JOBIF <br />730077 REF4 <br />APN <br />CR9 <br />FxP.DATN <br />8/p1/2020 <br />VAUD <br />/21/2020 TG' 8/01/2020 Dtdl[lEWAYS: ' <br />SIREN <br />MARIPOSA RD <br />ARF'A <br />STKN QUAD NE <br />TYPE <br />(2) -BELL HOLES <br />FORMS <br />SS/WW R-29, Trench Cut Policy <br />NO ES <br />SPECIAL CONDITIONS . <br />The undersPgnedhereby appliesforoot iissfontoexcauata,c nsfucfandlarotferluiseencroac Oil count Mg Right-ot-waydn . <br />the S _sideor" appt4ximate(y; ci fee Guile ca T <br />oz byperFo min- heiollawing work (esciiption of.wadc). <br />Vlatictnli[[cpmrrlenceonorabout —1 - fiotapproximately days, . <br />L ih2 undersigned, cetfify that! amthe owner ofthe respective property, or am quali(led to representfhe owner and ageefo dq No - <br />work described above in accordame With the rufw and regurafions of San Joaquin county and subjeo�to invee-von and approwL <br />6 04 -OIfk <br />signature ofkipffe-ant-Tlg <br />�ICEH—jRplfiEtryjCE54Cl&iICN.1Fl1&4V.WAtAA91E4R51qlGROAEHnIE1.TPEMIf(APPIICA70NCCG rA911aJ <br />5=1B-�o2Q <br />Data <br />