Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 0 — P ? " OFFICE USE ONLY <br /> To: San Joaquin County JOB 52 1 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE �! y <br /> VALID " TO / f DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA tj, QUAD He <br /> lio 10 !�-.4— L TYPE "Kka (:�iqw&Ekqr is <br /> (Mailing Address) FORMS <br /> NOTES <br /> (City,State, Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excav to c nstrucctt agnO/or otherwise encroach on County Highwa Right-of-Way on <br /> the S side of 1�� � r � approximately LI 4'd e mile- <br /> by�^ r�� l by performing the following work escription of work): <br /> Work will commence on or about — It for approximately 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 subject to inspection and approval. <br /> Signature of Applicant-Title Date <br /> MICENTRALSERVICESICLERICAUPUR-SU WNIP.4ASTER.PSIENCROACHMENT PERMIT APPLICATION DOC(09113) <br />