Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERW <br /> PLEASE PRINT: <br /> Date /,o -2 6 e 1 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 3 00,5-Z REF# <br /> Department of Public Works APN CR <br /> EXP.DATE - 3-1-16 <br /> 3 q q D VALID ' (z-3-C TO -C- DRIVEWAYS: <br /> (Applicant Name) STREET 4 z <br /> AREA QUAD 5Ic <br /> !® L-1 e7U_9 a.vt e TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> (City,S ate,Zip Code) <br /> (Area Code tleph�one a�) <br /> Sket Detailed plans may be submi e <br /> The undersigned hereby applies for permission to ex av te,construct and/or other ise encroach o"wi Right-of-Way on <br /> the Al side of E SvAo rA im approximately '3mile S Eof [!!4 Rt y Fa r.�J�� ±AA ,by performing the foription of work): <br /> ti ccJ a I- <br /> Work will commence on or about for 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 above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> 4-a $— 15- <br /> Signature of Applicant-Title Date <br /> LtICENIRALSERNCESCLERICALIPUB-SV.WKIMASTFR.PSe4CROACNN,ENTPERN,RAPPLICA710N.000(MJ13) <br />