Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT' <br /> �rJ / P( OFFICE USE ONLY <br /> Date (�y� <br /> F <br /> 3�SoREF # <br /> To: San Joaquin County CR # <br /> Department of Public Works TEo Co TO fS 0 DRIVEWAYS- <br /> (Applicant Name) <br /> STREET i�M6exy' s <br /> AREA`"—y&FZ='"eA QUAD_..�/E. ___. <br /> TYPE 'q046 BORE <br /> t-�(�Mailing Address) FORMS SS� 79 <br /> NOTE <br /> ,(City, State, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate, struct and/or <br /> en bath on County Highway Right-of-Wa on the <br /> s'de of <br /> othe wise fee /Qj*0 <br /> approximate y - <br /> by perfo min the <br /> of n <br /> f: lowing wgrk (description o work) r <br /> VZ •� lr i <br /> for approximately <br /> Work will commence: on or about P <br /> tap days . <br /> I, the undersigned certify that I am th� oewneerto doofthe thework respectiveb propertyabove in, or am <br /> qualified to represent the owner and age <br /> in County and subject to <br /> accordance with the rules, regulations of San Joaqu6�mxh r -0& <br /> ru� --- - Date <br /> Si ature of Applicant - Title <br /> RETURN PERMITS To: <br /> MAST- .P AFPESCHDL (6/70) PGAE <br /> JOB PROCESS1NCdi DESK- BLD 1 <br /> 4p10'Vlhst LAM � <br /> MCMM, CA 96204 <br />