Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date Q/�"T'r OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> y <br /> ll��,ttr"�trEXP.BATE <br /> "Gf!JG /.fes VALID TO DRIVEWAYS: <br /> (ApplicantNaa e) STREET Lr,i fZi RC. <br /> AREA TI%g�-1 � QUAD IV' <br /> tom " <br /> SS G+SG� TYPE l• <br /> (Mailing Address) FORMS ` <br /> S `a <br /> NOTES <br /> (City,Sta e,Zip Code) <br /> 2r'—S36 — 8146 <br /> (Area Code-Telephone Num er) <br /> Sketch(petalled plans may be submitted) <br /> The undersi ned hereby applies for permission to excavate,construct andlor otherwise encroach on County High Right-of-Wayy on <br /> the side of approximately 5'z 63 fet <br /> ile Lu3r <br /> of Y I4 by performing the following work ption of work): <br /> Ind <br /> Work will commence an or about_ f'�0. <br /> for approximately ,7J' days <br /> �� '27� <br /> i,the undersigned,certify that(am the own r of ih respective roperty,or am qualified to represent the owner 'agree ta'do the <br /> work described above in accordance with the rules and regulatlons of San Joaquin County and subject to inspection and approval. <br /> (��Signature of Applicant-Tit[ Date <br /> E�VB3V.41KutWF'T.+ZP8EJ7lA:t4fF><ENT PERNt�PPLM.A�I0K.occ N� . <br />