Laserfiche WebLink
APPLIC•ION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> -- OFFICE USE ONL_ Y -- - <br /> Date JOB # - RE F_# <br /> APN 10 ( - - � CRV# /0 7 Z P 5- <br /> To: San Joaquin County Highway Department. EXP. DATE y_t-0 <br /> VALID TO DRIVEWAYS; <br /> Y / STREET-LE,7 �`''� 0 l J <br /> -,(Applicant Na AREA Sr-,e�1 QUAD l� -1Z <br /> ,-- 1 w e 1,-lP <br /> FORMS <br /> _.qda'- Address)_ NOTE _ <br /> , (City, Sta(a Zip Code} <br /> (Area Code Tcicphone Number) <br /> Sketch(Defaile_d plans mw,,be submittedy <br /> 7 777- <br /> r <br /> The undersiped hereby applies for permission to excavate,construct and 1 or otherwise encroach on County <br /> Highway._Right-of Way on the 3 r— side of I3 Fy E t'L �--�.t ` ` - approximately <br /> 0 ..1 mile of iv Z , , by performing the <br /> following-,york:-(description of work j: O, A `/-__ __... <br /> _ <br /> Work will commenc8 on or about' MA,'>`/. /;71/`:S—" for approximately days. <br /> I the undersigned certify-that I.am the.owner of the respective property;or am quahfied_to represent the owner and <br /> — — -- --- .�.. - - — _ _ - ._. <br /> agree to do!fie work descnbod above in accordance nth the rules,regulations of ban 3oaquin C.ouuty and subject <br /> to inspection and`approves. <br /> .w. <br /> SIG_ _ CAitiTTITLE DATE.. <br /> - <br />