Laserfiche WebLink
APPLIPATION FOR EMMOACHMEIT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> JOB#_ _ REF# <br /> APN d/S -i>- z � CRV# /o]3,,rz V <br /> To: San Joaquin County Highway Department. gyp.DATE <br /> VALID TO _ DRIVEWAYS: <br /> o 1/ir�E STREET DLAlle sV <br /> (Applit Name) AREA o `x� QUAD 1,0u) <br /> ?49 dX X 10 T n'E_Tle6W C- : <br /> FORMS 72- z f <br /> (Mailing Address) NOTE --� <br /> (City, State Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County <br /> Highway Ria t-of-Way on the E-�4 z r side of 0 z/vE -5 F. /yG , approximately <br /> feet =WeD u of Cq'-e o 61 Acts ST, ,by performing the <br /> following wo : (description of Work): :vac, ;26-1VC._t/ IAXY 7;o e c, <br /> Work will commence on or about 41AI-s'zlee " 0/'j?)7j-- DIY for approximately -S days. <br /> I the undersigned certify that I am the owner of the respective property,or am qualified to represent the owner and <br /> agree to do the work described above in accordance with fhe rules,regulations of San Joaquin County and subject <br /> to inspection and approval. <br /> T <br /> SIGNATURE AP ICANT - TTILE DATE <br />