Laserfiche WebLink
APPLICATION FW ENCROACHMENT PERMIT 0A ;-1 <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLYf r, <br /> To: San Joaquin County JOB# f l o o o S REF# <br /> Department of Public Works APN CR#,� <br /> EXP.DAT E 11-1 -15 <br /> F>�� ENG1NE tNG CC-NS7P_UC_71Q,'J1NC VALID TO t I-/ DRIVEWAYS: <br /> (Applicant Name) STREET + <br /> AREA r QUAD <br /> 47uSTR1,fL TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> STc��-ro�i, CA gs�G <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> i / /7 <br /> Sketch (Detailed plarts)may be submitted) <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highteej.�Ilile <br /> Right-of-Way on <br /> the�Norrrt+-esc�crrN_sideof VINE STaEET approximately So TCTAt, <br /> of by performing the following work(description of work): <br /> V I rr� ?Kc�r ,C?cv E =rr FI�FBe-r s7�E'�r to -t'o Sc v�o Foxe <br /> Ti�AFFic Dc�T�r2 i-�e iz.4t�,eoAD f�P�Pit� Gv�2rc t�G-IN4 +�oN� �c=.¢2 ca,�nr�iz c3� <br /> r2oc55El�E27 S7rrE�T D S 7,�EE i C Z f`�CN D ' SIGrNS 'Tei BE R�ccF a" vinrE ST ger <br /> f�ETtc�EEnf F/LBE1Z T S7PEET D 5112EET �'N SIC<N �7�cy C/YC�pAfN TEN Cr�i) FFcT� TpT�¢G 4F <br /> "Tip iR-�y Com) Fec—r <br /> Work will commence on or about 10 -acs- rS —for approximately "rwcv C� 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 pplicant-Title Date <br /> E:1PUB-SV.WMMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01100) <br />