Laserfiche WebLink
C coHCIA 5 ,t <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date / OFFICE USE ONLY <br /> To: San Joaquin County JOB# l QO S REF# <br /> Department of Public Works APN CR# <br /> !CIS r�V Cjj EXP.DATE L-VALID (z„-(g•I¢ TO Z- / -j s DRIVEWAYS: <br /> (Applicant Name) STREET ch e <br /> AREA a PAD <br /> :57v,_/J /31ZIS4 Si• TYPE <br /> (Mailing Address) FORMS sf vkl x aj <br /> NOTES <br /> (City, State,Zip Code) <br /> 725- 4 -577 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies forpermission to excavate,construct and/or otherwise encroach on County Highw Right-of-Way on <br /> the E146T sideof C� rLo�EE �1�. <br /> approximately /3 S ee ile NOerN <br /> of by performing the following work(description of work): <br /> Work will commence on or about / .Z - %- —/y _for approximately 20 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 /> 4U00"Pre of Applicant-Title Date <br /> N C_ -'R�E�b Cc?i C:.==.r,1'._:?'}�V N't'NPa'=��4,c`iC�CA�F•MEv"?_'."A',- ?7'.CA-C`,3CC <br />