Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT -- <br /> vr.SASE PIYINT <br /> Date 1-112-10r. OFFICE: USE ONLY <br /> TO: San. Joaquin County JOB # �� REF # <br /> Department of Public Works APN # <br /> EXP. DATE 2Y o <br /> G& 1M�(�0.W.`/ VALID. l TO 2 DRIVEWAYS: <br /> (Applicant Name) STREET to rl4i AVB C Cbl Iwt; <br /> AREA ILe:w 4uAD S E <br /> S S VI), C (off .r TYPE I?AQA2 G60su(ZM_— <br /> (Ma�ipliingg Address) FORMS �� f-- R- 2d <br /> Gtr,�' 2 or, 'NOTE <br /> (City, State, -Zip Code) <br /> 2.0 R 4 8- 03 a2 <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to .excavate, const <br /> otherwise-encroach on County-Iii hway Right-Of-Way--On the S8,rtitiar QLe r^vf' <br /> - <br /> 0 o tSe A s in A �t7 RACepproximately feet/mile <br /> of '. ,. by performing the <br /> following work (description of:work) : <br /> s axd r 0 0d <br /> Work ce on or'about 2 6 for approximately <br /> for- <br /> w " I,- the ,undersigned certify that I am the owner of,the respective property, or am <br /> A9 qualified to represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations 'of San Joaquin County and subject to <br /> inspection and approval. <br /> Sign ure o Applicant tle Date <br /> F86S <br /> .PS\ ®L (6/00) - ,\. <br />