Laserfiche WebLink
Vie, C C'A I <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE - S <br /> ( �-� VALID ll.-2 6"I TO _ S DRIVEWAYS: <br /> (Applicant Name) STREET <br /> � � AREA F <br /> &WQUAD <br /> � � j�fi SIVy TYPE �?p <br /> (Mailing Address) FORMS S j <br /> qq c5,!50 NOTES <br /> !(City,State,Zip Code) <br /> A ISJ -79 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for per(nission to excavate,construct and/or otherwise encroach on County Highuy Right-of-Wagon <br /> the . side of t� a>>� - approximately 44 1 fee ile LUPI <br /> Of-M A L.)71 bi Y CZE §:-?E�X 44 6A ki? , by performing the following work(description of work): <br /> Work will commence on or about I ► -2-0- 1 15 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 d cribed above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> 3- <br /> MigiYature of Applicant-Title Date <br /> MICENTRALSERVCESICLERICALIPU&SVW AAASTER.PSIENCROACHMENT PERMIT APPLICATION DOC (09113 <br />