Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: S _ 4® v 0 0 S <br /> Date Z 1 3 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73 0 0 S1 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE Z I + <br /> ,,2 j VALID —1 /6TO 14 DRIVEWAYS: <br /> (Applicant Name) STREET �4 gA'4f, Pp erA <br /> AREA --2�-- <br /> TYPE �r QUAD <br /> (Mailing Address) FORMS 5f14/V, <br /> NOTES <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> wifr <br /> � - a U1 W `r�7�-,Y �� 1)�A 4 I re f t 4 `�j`;'ap'b ���`j�v L4) <br /> The undersigned hereby applies f�ermiss�Ion to excavate construct and/or otherwise encroach on County High�Right-of-Way on <br /> the side of >�J Ft` r� approximatelyZ� f(eef/mile 3' <br /> of 4-t;J izn ,by performing the foil 'ng work(description ofpork): <br /> I5JL,1�� KfE 4wr) 1EYT U>t ! i(i '1 Ca'+ S i'1�' y� 1 ll)1 IFS <br /> NIS -pit, is !,u ri E n ie-T' i i E5� -w b - <br /> Work will commence on or about P C A U' titi 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 abo�a in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> r <br /> ate o p licant- tle__. Date <br /> E'q?J3SVXOAAS-,EP_PS_I:G70PCWAEWPE:WTAPPUCA51LWA0C(107) <br />