Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date -7- 2'-1 LO I L4 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 730 REF#! <br /> Department of Public Works APN CR# <br /> EXP,DATE - - <br /> P.G . E • C a wm P ia'- y VALID i n TO _ - DRIVEWAYS: <br /> (Applicant Name) STREET >dc lone <br /> AREA L 0z QUAD Alf- <br /> 560 <br /> SS0 S--I►.LWA-T&-R {Z TYPE alo n? <br /> (Mailing Address) FORMS �,S -2- <br /> NOTES NOTES <br /> (City,State,Zip Code) <br /> clIli^ Ito0 " 19Cbb <br /> (Area Code-Telephone Number) (4-e r}er <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highwm Right-of-Way on <br /> the 10 9-St side of N. J�4GlC Tpii& QQ approximately 1?-So fe( ef/ihile 50�'t-t-} <br /> of >: . U t cm 2 QI0 , Lo 61 by performing the following work(description of work): <br /> STA-%-1L-%Yj , ISTII1 G lPDLt; <br /> POLE IS NOT TALL ENOUGH FOR-RECLOSER AND WILL NEED TO BE REPLACED <br /> Work will commence on or about for approximately Z 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 /> Z- ao y <br /> Signature of Applicant-Title Date <br /> ENUSSV.1lIM{ASTERPSIENCROACHLtE1RPERA1f(APPLICATIOi7.000(O1gO) <br />