Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 3w REF <br /> V mop, <br /> Department of Public Works APN CR# <br /> M'� � i� EXP.DATE h <br /> -1�4arne) VALID 0 i 45 To DRIVEWAYS: <br /> (Applicant STREET Dg <br /> N T:� AREA QUAD 5F- <br /> I. - — TYPE re- <br /> P- <br /> V(IMVIaLilingg Address) <br /> FORMS <br /> NOTES <br /> ity,State,Zip Code) <br /> -3�? -L5 3 "') <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> P(022,9- <br /> The unde 1 ned hereby applies for permission to e cavate,con�,truct and/or otherwise encroach on County Highway Right--of-Way on <br /> the side of <br /> 0 CA VV approximately <br /> by performing the following work(description of work): <br /> Work will commence an or about for approximately days. <br /> 1, 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 arid Subject to inspection and approval. <br /> _L <br /> -2 I <br /> Sigattire <br /> I aL of A LE ;t <br />