Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 313'[is— UFFICE USE ONLY <br /> To: San Joaquin County FAREA <br /> j (,Q(� S REF# <br /> Department of Public Works <br /> CR# <br /> S-l <br /> -7- 15' TO <br /> (Applicant Name) - S DRIVEWAYS: <br /> QUAD <br /> Po So I�IU TYPE ��� <br /> (Mailing Address) FORMS <br /> NOTES <br /> �p\1r'C■ �� IS"3�q <br /> (City,State,Zip Code) <br /> (2e9) 41 l- yat?o <br /> /(Area Code-Telephone Number) <br /> 14 L"YAK%x d @ dw.w oca,v.L.Go Y✓� <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate,construc and/or otherwise encroach on Qounty Highwa Right-of-Way on <br /> of / C->~ p� t�-bLIQV�'(�� � approximately 0 ile— _ <br /> by performing the following work escription of work): <br /> Work will commence on or about 3 <br /> for approximately ! 13' 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 /> �L� (srperl <br /> Signature of Applicant-Title <br /> Date <br /> M:(CENTRALSERVICESICLERICALIPUBSV.WKIMASTER.PSIENCROACHMENTPERMITAPPLICATION.DOC (09113) <br />