Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE MINT- <br /> Date _ `` (� _ OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Wcrks 4Pi4 CR# _ <br /> / EXP DA''E <br /> VALID 4--2-3-15 TO g-(-(S DRIVEWAYS- <br /> Applicant Name) STREET ['C yy,a h 7 <br /> L AREA — QUAD <br /> � -� 3 _ 7v TYPE - <br /> (Mailing Ad r .ss) FORMS <br /> NOTES <br /> (('ity,state,7ip Code) <br /> ��_ (Ar.,a Code- ele hove Number)-72 <br /> Sketch (Detailed N'ans may be subr,iitted) <br /> 5Em ffTmc",e-p, .-TRAvivi- a eo -ve.oL. 4>LA-r) f ef, r wre-D 6 N-6 <br /> i <br /> The undersigned hereby applies for permission '.,)excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the E'AC>T side of C-VK15r VRv-1 Rfl approximately ee _of 5C_Se �E ice• __ --- by performing the following work(description of wcrk): <br /> _ggw- oVA aF f1 w►IFIAL S6-AFw,. oeA%L�tN(s 'r10Qr^%t,%A L S`�STEw1ftiroE S_KT) <br /> G��LOR�►lt_ . <br /> Work will commence on or about for approximately __ ' days. <br /> 1,the undersigned,certify that I am the owner of the respective property,or am qualified tg,(epresent the owner and agree to do the <br /> work descri d above in accordanA with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> pcAt4 , ernrto1LAfrG1oIVQIrt✓ P_ 5Vc- 5 . C-0rn <br /> Si ature of App icant-Title Date <br /> M:ICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION DOC (09/17) <br />