Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT. <br /> Date . . <br /> OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department of Public Works JOB# "13005-Z-4m REF# <br /> APN <br /> EXP.DATE _ CR# <br /> VALID <br /> (Appiicant Rame) STREET0 ri '�� DRIVEWAYS: <br /> t c Svc. <br /> AREA $fsce '„q <br /> TYPE QUADS <br /> ` <br /> (Mailing Address) ! °eC.*c�,xt� ;, tr <br /> FORMS - 7 <br /> NOTES ----_ <br /> t"LY,State,lip Code) <br /> (Area Code-Telephone AU—mber-) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Hi <br /> the i� side of � �.� i �.., <br /> of v d , r aAProximately tY 9hway Right-of-Way on <br /> ------------------------ <br /> {_ .. eet/mile <br /> by performing the following work(description of work): <br /> Work will commence on or about ,, _ <br /> 1, fhe undersigned,certify that I am the owner of fhe respective properly,or am qualified to represent th days. <br /> work described above in accordance with the rules and regula#ions of San Joaquin County and subject to inspection e ownerp and agree to do the <br /> on and approval. <br /> -" -W natvre of <br /> g Apr►cant-rare <br /> WCEfnRALSER14CE9IXERICAUPUBSV."Kl'M'ER.PSnICROACHKENTPE ,rrAPPLICA-aoll.000(4113) <br />