Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: i <br /> Date 0406ef- QT_ Z009OFFICE USE ONLY <br /> To: San Joaquin County JOB# 110006- REF# <br /> Department of Public Works APN CR# <br /> _ EXP.DATE it. I.09 <br /> � f 1� <br /> iroc��^pn�l r-Lq er VALID •IS TO i J. .Oct. DRIVEWAYS: <br /> 1 (Applicant Name) STREET RIADo-M Sy. <br /> AREA S-roe-roel QUAD 14I+ <br /> TYPE '7r.z-t4C 111464 <br /> (Mailing Address) FORMS c�=��uv� -I� <br /> NOTES <br /> OA S7,159 <br /> (City,State,Zip Code) <br /> �L C,:;46'— i q <br /> ( rea Code-Telephone N ber) <br /> 20q <br /> Sketch(Detailed plans may be submitte ) <br /> 5e,e- cAPC RE Drawina PM 3072q*7GO <br /> -51 e- ck lt"-ea TIP-Mpc ra.Ir y -Tra. �C- V1k r0( pl a k I ! <br /> I <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the not-A-h side of_.b�aAh4 i O++ <br /> approximately S C1 20 feet/piie <br /> Of by performing the f_ rwino work(description of work): <br /> } ` <br /> t <br /> Work will commence 6n or about 00-A-g6 151; 2C)QC-1 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 described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> dl <br /> _ Our tol 9'l 2009 _ <br /> Sign re of Wcant-'—Title­ Date <br /> EP43-SVWKW0.STER.PSENCROACHYENTPERYTPPRICATIORDOC (DUM) <br />