Laserfiche WebLink
� 1 <br /> APPLICATION FOR ENCR®.ACJjMENT PERMIT <br /> PLEASE PRINT: <br /> Date j-n 1 q 1 <br /> OFFICE USE ONLY <br /> To: San Joaquin County FJOB# 7 3 00 7Department of Public Works 7 REF#CR# <br /> EXP.DATE <br /> TE L? Q�)L: I C,E VALID <br /> (Applicant{dame) STREET �-� TO DRIVEWAYS: <br /> / AREA °�,,���as� D Elmwood Airt_ <br /> Loa c�, 1.�1`" �l 1✓II•f= ST TYPE � QUAD C C <br /> (I ta►l►ng Address) FORMS <br /> ` NOTES <br /> (City,State,tip Code) <br /> 0 1 1,; V -- <br /> (Area Code e 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 Highway Right-of-Way on <br /> the side of y <br /> of approximately <br /> feet/mile <br /> by performin the following work(descri tion of work <br /> i 3y_ I <br /> Work will commence on or about <br /> a Pu 114 In It <br /> _for approximately days. <br /> 1,the undersigned,certify that I am the owner of the respective <br /> 0e rope / `t <br /> work described above in accordance with the rules and regulations of an Joaquin qualified <br /> ounty ndrsubject to owneresent the spect on and approval. <br /> to do e <br /> Signature®f �.Pc i (0 (q <br /> Applicant Title <br /> Dat <br /> .M -SV.WK"ASTEPPSIENCROACHAIEMTPERAfITAPPLICATIOFLDOC(09113) <br /> 1 <br />