Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> .+ a <br /> Date ,.OtJ OFFICE USE ONLY <br /> To: San Joaquin County FAPN <br /> �1l7q�c��°' REF# <br /> Department of Public Works CR# <br /> Ley Ik �Jd� EXP. DATE <br /> h / VALID >` p TO �� /+ DRIVEWAYS: <br /> (Applicant NamLe) STREET ` < <br /> j / -��J1&-( l �t[�7z /� TYPE AREA QUAD <br /> C� (MailingAddress) FORMS g5 uy�j <br /> 'hC4 1�5-��o NOTES <br /> (City,State, Zip Code) <br /> 9- 9 ycf– 134,"s— <br /> (Area Code-Telephone Number) <br /> Sketch(��Diettaailed plans may be submitted) <br /> ._ � �`` SOT loG�,fi�►+� , Lam .lax� s�� <br /> �Yy� �' � E:vicQ a� COtert'�r Mct �►'i�q,h�cfs r�?aq/ � �-'` <br /> �� �.fsaf�" t�t'1'c �?ri`i'q,f e �✓G f e w'�r0 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the Uye bf side of ort r a <br /> .8 dila <br /> by performing thefallowing wo (description of work : <br /> eN a ro wit t Gr- fie+f ��1 T t t y3ir,A al, wr <br /> .fb t 4 a�e.I <br /> Work will commence on or about <br /> — 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 descri4wdl—bove in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signature of pplicant-Title <br /> Date. <br /> E:PUB-SV.WKVMST[R.PSW=NCROACHWNT PMWT APPUCATION.DOC (01/08) <br />