Laserfiche WebLink
APPLIPA i ION FOR ENCROACHMA1 PERMIT <br />PLEASE PRINT: <br />Date <br />To: San Joaquin County highway Department. <br />(Applicant Name) <br />(rv1ai1ing kdress)1 <br />(City, S to Zip Code) <br />Zvy -- ¢ C Z z-? 3-7 <br />(Arca Code - Telephone Number) <br />JOB # <br />APN <br />NH1 �' <br />OFFICE USE ONLY <br />REF# <br />CRV# / a 7 So ! <br />VALID��� TO DRIVIJ�VAYS: <br />E" <br />STREpyw&S E # <br />AREA _ 5�,� QUAD S <br />TYPE <br />FORMS s-Sleu U, `7 <br />NOTE <br />Sketch (Detailed plana may be submitted) <br />57 5- S, DAWNS s3bl <br />r <br />CM <br />c_n <br />-o <br />C <br />jj <br />r <br />Q� <br />C7 <br />ccz G- <br />•• <br />m <br />Jr.. <br />--� <br />The undersigned hereby applies for permission to excavate, construct and / or otherwise encroach on County <br />Highway Ria -of--Way on the 1N,,,; -5T side of 2.t . approximately <br />l<; r4a e gesy mik of by performing the <br />following work: (description of work): Zee�e�� <br />Work will commence on or about z Ic— 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 <br />agree to do the work described above in accordance with the rules, regulations of San Joaquin County and subject <br />to inspection and approval. <br />DAT <br />