Laserfiche WebLink
�S �2 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date I Li OFFICE USE ONLY <br /> To: San Joaquin County JOB# W� p0S" REF# . <br /> Department of Public Works APN. CR# <br /> EXP.DATE/ 2 62!4 <br /> V C Sr I VG, C�G.'�'�S CC7yLS�1'"UOtl®1/\ VALID <br /> ? TO DRIV <br /> ry� EWAYS: <br /> (Applicant Name) STREET <br /> AREA QUAD , <br /> 1155-5- JtAJ.V\ b14. TYPE <br /> (Mailing Address) FORMS tr:7 rL <br /> _ NOTES <br /> (City,State,Zip Code) <br /> (cl 2-) i8 zC1-- '�Z2-0 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> lGLns cLcW <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the!st/wtSr sideof Ly%gt eyr StoorAMcMp Moor. approximately 14,000 ee . <br /> $e�2o-VI a mi o- X00A I Ha- v qlz,/, by performing the following work( escriptlon of work): <br /> o�rha t2 e�c9t�ra�:o to d� et--;s+►v&a . AdAa seg--vi ayx <br /> Work will commence on or about Aw1�lla U V4 for approximately t 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 above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Pro r� fty1-ei%✓ 413 0 i q <br /> Signature of Applicant-Title Date <br /> AllCEN,RALSMCEMCLERICALIPUBSV.WKMSTERPS04CNOACFUENTPERMRFPPLICATIOM.DOC(0173) <br /> I <br />