Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> i <br /> Date \��,�� j. , OFFICE USE ONLY <br /> To: San Joaquin County Joe# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE -t0 t4 <br /> L(X) VALID tQ TO 6-ta-f,} DRIVEWAYS: <br /> (Applicant Name) STREET iAp%Atk. Rni Macau ftp �ras;,tJ (2.D• <br /> AREA 910cc1 QUAD <br /> TYPE '�tc0r-LA 4 P.zFy� [ t�`5i► Np.�F�MAf4iTr16 <br /> (Mailing Address) FORMS <br /> NOTES <br /> rA rN W,2z> - AA 'I:06 &.A, 'a tb: <br /> �—' (City,State,Zip Code) <br /> c° sen-t08ca I <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> n cs <br /> 14 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of approximately feet/mile <br /> Of by performing the following work(description of work): <br /> Qo � <br /> c� <br /> 0�,�_,�"7 rr�:�os nrr�u.r 1�•�t�ci 1 CI"��.AX$rZ 15 c'�r� Cs�Li�� Yh n�5 <br /> Work will commence on or about tAcLA, 1 for approximately �� <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 above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> f Applicant-Tide Date <br /> a!SERv..LGrtUL Ki.UL L5Sv ViK,",ASTEH FSK_'FHDaCM;d-':FfRNrt ff-�:CATO-N10C <br />