Laserfiche WebLink
APPLICATIOM FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# j 0 y 7 REF.# <br /> Department of Public Works APN CR# <br /> EXP.DATE -( -1s <br /> C <br /> L L T(���I A ,I°E e,[ VALID ¢'1=1T TO ��_��_ DRIVEWAYS: <br /> (Applicant Barre) STREET <br /> _ AREA S QUAD <br /> Q F)9 l� E-TIL` TYPE B>E�Ihrs/r - -- --- <br /> (Mailing Address) FORMS .5 14/ / R <br /> �T L K-1 © NI � `7 5a�J -NOTES <br /> (City,State,Zip Code) <br /> (urea Code a Telephone dumber) <br /> Sketch(Detailed plans may be submitted) <br /> The undersi ned hereby applies for permission to excavate,construct andlor otherwise encroach on County Highwa Right of-Wa on <br /> the W- a side of N e(.� o <br /> of ,,„, �, approximately ° fee mile.` <br /> by performing the following work cription of work). <br /> �r-1" Rao <br /> 1x4 4 <br /> STS. <br /> 'n I 'n <br /> 4 �� 2 <br /> Work will commence on or about i I for approximately r <br /> ���5,o)rSa <br /> days. <br /> 1,the undersigned,certify that l am the owner of the respective pualified 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 /> Signature of Applicant o Tit1b Date <br /> M:ICENMALSEMCESICLERICALIPUBSV.WKNIASURPSIETCROACHAIEt4TPERMRAPPLICAT70NDOC(09!13) <br /> 1 <br />