Laserfiche WebLink
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 •!, <br /> 4a7'ly ' VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET 6AIx <br /> _ AREA G/ QUAD _ <br /> /2E� T,6 y /I V- TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> (City, State,Zip Code) <br /> 2—`2 6a,a f-// <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highwav Right-of-Way on <br /> the /,Va t& side of W,L i vl-le 120 approximately 41 ` Qfee ile <br /> of 5. c`� /;2J a , by performing the following workription of work): <br /> Work will commence on or about 7--Z7-0!? for approximately "7- 2 17-c9 3 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 described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> �o- � 21 -0 <br /> Signature of App icant-Title Date <br /> Y':FORMSS 8 TEMPLkTMENCROACKENT PERMIT APPLICAT10N.dx 108'081 <br />