Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date May 18, 2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 11D00s REF# <br /> Department of Public Works APN _ CR# <br /> Mark & Kandee Aiton EXP.DATE 7 tZ 1 _ <br /> On Your Mark Events VALID ; iz r TO 7 12-115' _ DRIVEWAYS: <br /> (Applicant Name) STREET f& i <br /> PO Box 1199 AREA zA QUAD Ale <br /> TYPE <br /> (Mailing Address) FORMS ✓ -/ <br /> NOTES <br /> Arnold, CA 95223 A 3.46 A15- n/ A/ AV 019? <br /> (City,State,Zip Code) Tuc Y /2 AWS- 490,%, 40,160 <br /> AW 711"o- <br /> 209-795-7832 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> 1Z. <br /> Se= attached Letter of Intent and Map - Start date, July 1!!�, 2015 <br /> The undersigned hereby applies for permission to excavate,construct andlor otherwise encroach on County Highway Right-of-Way on <br /> the side of 66,00E 0t C*- ,— , approximately <br /> Of _,by performing the following work(description of work): <br /> S-ezaz-ta c�i� <br /> 57 o44 6 06?404 72) <br /> 1Z <br /> Work will commence on or about Ju 1v 'F ?a15 for approximately 1 days. <br /> I,the undersigned,certify that 1 am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> Work desuribed above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> A/ a May 18, 2015 <br /> Signature of Applicant- itle Date <br /> MUGEWMSE.ROCE54CLERICAL)PUBSY.WKVMSTIRPSENCROACHMENTPEMRAPPLICATIOILOCC(W131 <br />