Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date /— / f- Z r./ <br />OFFICE USE ONLY — -1 <br />To: San Joaquin County <br />JOB # 730052 REF # <br />Depa nt of Public Works <br />ARN CR # <br />CJ—/✓ <br />EXP• DATEDRNEWAYS: <br />VALID /31/2024 TO 1/20 -- , <br />(Applicant Name) <br />STREET Kile Rd. <br />AREA odi QUAD <br />/, <br />C �Lcl N'\ //1 <br />TYPE Aerial Work <br />FORMS ssn <br />(Mailing Addres ��- <br />,^y <br />NOTES Special Condi <br />(City, State, ZJp ode) <br />/ (, - 1 1 (o % <br />(Area Code -Telephone Number) <br />STS ; v IPr'l', is R <br />(Email Address) <br />Sketch (Detailed pl ns may su submitted) //�✓ <br />" A ,4 � Jx <br />r.� X " G_P <br />Lc� ta" CL s "" c� A� R11 0� <br />The undersl hereby applies for permission to ex v e, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the Iy side of li IC approximately 12-Y ' - 2-2-'1- feeUmile <br />of Krq lam— 0d, by performing the following work (description of work): <br />L1 Z I _YI./_ CEJ+A L4 O X S ✓�i OAIi , <br />3 Sa I glo"!N I <br />Work will commence on or after - 3 •7 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 ance th the rules and regulations of San Joaquin County and subject to inspection and approval. <br />-Z 91 <br />re of Applicant - Title Date <br />•+we��au�,.R.aawr,.a*PEwx,uow,.x i <br />