Laserfiche WebLink
- ' -1 ►L,�C:A'i'lON FOR ENC ROACH , NT PE10.CiT <br /> PLEASE PIUNT: <br /> OFFICE USE ONLY <br /> Date JOB # REFti <br /> APN - - CRV410 k- 9 7 <br /> To: San Joaquin County highway Department. Epp DATE / b Z <br /> r / V,rA .ID /O 2 'T .1,�5)Iz Z !o DRIVEWAYS: <br /> SGDT�C�/[�/� 1M�/S�Ti�`1 TEG�ji+�OGd lyy LY STREET / <br /> (Applicant Name) AREA 5//Gr/ QUAD ms <br /> TYPE1� rriro.es G -7 <br /> //•V- Taza v 156-/,r�E XR0 FORMS (J <br /> (hZziling Address) NOTE <br /> (City, State Zip Code) <br /> (Area Code -Telephone Number) <br /> Sketch(Detailed plans may br submd"llet'.) ` <br /> d 4'13;111:: <br /> The undersigned hereby applies for permission to excavate, const�ct and/or otherwise encroach on County <br /> N.ighway Right-of-Way on the side-of approximately <br /> feet /mile S ofb rformin U <br /> ._� Y performing <br /> following work: (description of work): T—VG�� <br /> Work will commence on or about b 2 3 for approximately 3Z,5— days. <br /> I the undersigned certify that!,un the owner of the respective property, or am qualified to represent the owner a <br /> ? agree to do the work described above in accurd.Lucc: with the rules, regulations of Su-1Joaquin County and subjc <br /> to inspection and approval. <br /> SIGNATURE OF APPLICANT - TITLE DATE <br />