Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEAEk�llh�T�: <br /> ZoDate (o 4 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73:(20-S-,2 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID DRIVEWAYS: <br /> ............... 1-26- 1 b TO 2--15-16 <br /> (Applicant Name) STREET ed <br /> 1> <br /> AREA A:�/ lAbi QUAD <br /> TYPE <br /> (Mailing Address) FO <br /> NOTES <br /> J, <br /> (C11)f,State,Zip C6de) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> D <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right of-Way 99 <br /> the -4 side of E��t �J. <br /> 09 -?�, approximately JV\\Lk, feet/mile '1,r <br /> of 1�) �z p- I tzyd4k M 11�J ki CA q <br /> Lq�2-35,0_ by performing the following work(description of work):- <br /> LE-i <br /> Work will commence on or about or 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 bo d-ric with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signair" fleeman itle Date— <br /> EIPI,B-SV.WAWTER.PS'ENI.CF'ME',4TP-WiTi�WCATION.(;; (01J08) <br />