Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRESET: RO-33 <br /> Date <br /> &L-LL ) OFFICE USE ONLY <br /> 10: San Joaquin County JOB# 2V Q 77 REF.# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> l= Q f F� I�� (�(�)C L= VALID 4_?SIS TO _7_] _(S DRIVEWAYS: <br /> (Applicant Name) STREET M�chlcMtl 411 <br /> AREA L.191-6 �I -T—EE S� TYPE QUAD [C <br /> /3r I1 yrs l� <br /> (lNlailing Aldress) FORMS U IA61 Z �4 <br /> � 9.5 -NOTES _ <br /> (City,State,Zip Code) <br /> ( pea Cade�Teleplo®ne�lrarnEaer) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for pM <br /> ssion to excavate,construct andlor otherwise encroach.on County Highway Right-of-Way on <br /> the Ho r- f1 side of <br /> of approximately Y �J ' fee mile-&-64- <br /> by performing the following work scription of work): <br /> y So <br /> WOrk will commence on or about fo pproximately days. <br /> C� t l� y <br /> t,the undersigned,certify that E am the owner of the respective property, ram qu ed 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 d Title Date <br /> 6L'10EWMSBUCESCLEPJCALVU&SV.WIvoA57II2pSENCROACH91E?dipERNIfTAppUCAIIUKD0C(09113) <br />