Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date -0�� �' ' OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN _ CR#. <br /> EXP.DATE ^1� /-S-- <br /> (A <br /> sem(A VALID -71-2v/5"TO %—I-2U DRIVEWAYS: <br /> (Applicant Name) STREET e_v,Spti <br /> 2® AREA `� �L y QUAD S <br /> TYPE <br /> (Mailing Address) FORMS /taJ L <br /> NOTES <br /> (City,State,Zip Code) <br /> %) 1�fl0 • 0512. <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> im <br /> The undersigned hereby applies f r permission to excavate,gonstruct and/or otherwise encroach ocLCounty Highway Right-of-Way on <br /> the 5i uw�-fAA 4- side of . 'PAA�V"00 9Z0 -approximately-..... 50 Omile t`+ <br /> of 1411 V—'OM N(tiSS560 by performing the following work(description of work): <br /> �(oen„htna, sannnp ��� a Cxls �, �Irow�► w -r,� ov�t �t,n� �u�i S . <br /> Work will commence on or about4 7-17111 S' <br /> for approximately 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 ab ve in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval, <br /> Signature of Applicant-Title Date <br /> b110EN1RALSERIICESCLERICALWURSVWKV.IAS1ER.PSIENCROACHh1ENIPERA1Il APPLICAI[OIIDOC (0917) <br />