Laserfiche WebLink
i <br /> 19 S I <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: '" 1 0 �)8 2- <br /> Date -3 '' OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> i...r�t�.:.:a EXP.DATE — <br /> VALID 0 DRIVEWAYS: <br /> (Applicant Name) STREET <br /> t AREA AD ' <br /> ' TYPE ' <br /> � yy (Mailing Address) FORMS 5 <br /> t CA NOTES <br /> (City,State,Zip Code) (M„1 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> ATT <br /> The undersigned hereby applies for ermission o excavate,construct and/or otherwise encroach on County Highwa Right-of-Way on <br /> the side pf approximately_N� �emile <br /> of t.�x.V V� by erforming the following work(description of work): <br /> CA C-tszal <br /> Work will commence on or about "' —' for approximately days. <br /> I,the undersigned,certify that I amfthe owner of the respective property, or am qualified to represent the owner and agree to do the <br /> work described b ve in a Gordan e wAthe rules and regulations of San Joaquin County and subject to inspection and approval. <br /> 7-10 <br /> Sign ref "�Iicanf Title Date <br /> M'CENTRIW SERVICE'S±CERICALPUO S':YJN':MASTER PS.ENCROACIPdENT PERMIT APPLICATION DOC 10913) <br />