Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �7`�'dr� �S`Z 7// OFFICE USE ONLY <br /> To: San Joaquin County JOB# -?3(2 ';7qREF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> AT&T VALID 7^��—lr 0 ! -!S DRIVEWAYS: <br /> (Applicant Name) STREETe/ AA1 <br /> f <br /> 5555 E OLIVE AV AREA QUAD / <br /> TYPE <br /> (Mailing Address) FORMS S Wks �L <br /> FRESNO, CA , 93727 NOTES <br /> (City,State,Zip Code) <br /> 559-454-3437 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Lj <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the WEST side of HWY 99 EXIT RAMP _approximately 400 ' feet/mile SOUTH <br /> of E ARMSTRONG AV by performing the following work(description of work): <br /> Location ) South side of F Armstrong Av a 0' /IJ n Pearc_on Rd (APP 3100E Armstrong Rd) <br /> LeEatlen 3) South side of E AFM54E)Rg A". -PP 150' '-=-/G West:Lane. <br /> All Three locatt re DIG UP OF BURIED CAKE T5 PER-EORM <br /> Work will commence on or about June 15-June 3Ci for approximately 3 DAYS 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 subjectto inspection and approval. <br /> Signature of Applicant-Titled Date <br /> F1ILEtrRALSEP..VICESICLERICALIPUB SVWNIMASTER PSIENCROACHMCNT PERMIT APPLICATION DOC (09113) <br />