Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT:T <br /> � <br /> Date y /s— OFFICE USE ONLY <br /> To: San Joaquin County JOB# <br /> Department of Public Works REF# <br /> APN CR# <br /> EXP.DATE <br /> VALID TO DRIVEWAYS: <br /> - / (Applicant Name) STREET <br /> `lCt1� WISJ-- G/� AREA QUAD <br /> TYPE <br /> (Mailing Address) FORMS <br /> 4N-7 7 NOTES <br /> (City,State,Zip code) <br /> zl0V - 3l(o-17 7 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> 311 Y S-1 <br /> The un ensign d hereby applie.§for permission to excavate,construct and/or otherwise encroach on County Highway Right of- ay on <br /> the f side of <br /> of W �` approximately 1Okj _ ,mile_N <br /> l � Y__1 by performing the following work(description of work): <br /> lrU i <br /> V <br /> Work will commence on or about o s r ---- <br /> _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 ac dance with the rules and regulatiois of San Joaquin County and subject to inspection and approval. <br /> Signature of Applicant-Title <br /> Date <br /> "'CE"RALSERVICESCLERI01LIPUgsVWKLNASTERpSpJCROACWENi PERK,IPAPPLICAIIONAOC(09J13) <br />