Laserfiche WebLink
O'n4r," <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# <br /> Department of Public Works APN 0 0 REF# <br /> CR# <br /> EXP.DATE <br /> Ayf <br /> VALID <br /> TO DRIVEWAYS: <br /> (Applicant Name) STREET e-- <br /> r. ;�f <br /> AREA 10ti, QUAD 5 C <br /> TYPE <br /> (Mailing Address) r-') FORMS - <br /> 7, <br /> NOTES <br /> (City,State,Zip Code) <br /> ----(A—rea Code-Telephone Number) <br /> 7%elcl 'Detailed plans may be submitted) <br /> 6et <br /> The undersigned hereby applies ermission to excavate construct and/or otherwise encroach on County <br /> the LOW, Highway Right-of-Way on <br /> side of LT <br /> approximately feet/mile <br /> Of Ln t—�rr <br /> )Iv' by performing the following work(description of work): <br /> - <br /> -il <br /> N'7, <br /> CA C�s'20-3 0 <br /> �7 -x <br /> �t <br /> Work will commence on or about for approximately days, <br /> 1, the undersi ned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> d;above c— <br /> work describ bove in a6 ordanci with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> k <br /> 0 Pplicain't Title <br /> S T-97,-t-U-r- ----ppli h1i Date <br /> E,.ft'S.-S-V-W-KW.IAS-TERPMENCROAr-,imENTpEFWAFpt,CATIMCOO(Dm) <br />