Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OGT 15, 2.00 9 OFFICE USE ONLY <br /> To: San Joaquin County JOB# )DC=15 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 12.0x. 0'i <br /> J VALID TO A2•I.o£ DRIVEWAYS: <br /> (Applicant Name) STREET Nka4ecs <br /> J AREA o.n c,co. QUAD S9 <br /> 11011 1-► C� N kJ AY IZ O TYPE - !&L!}a'Le I T"fA4- '5V UtGK <br /> (Mailing Address) FORMS Ssrt,�w y 1e-Z <br /> NOTES <br /> MAIQTE-C..A , GA <br /> (City,State,Zip Code) <br /> 0-09 - Z 4 <br /> (Area Code-Telephone Number) <br /> Sketch Detailed plans may be submitted <br /> � EtJGRo�-N M�.n1T <br /> 0 <br /> W N <br /> , � 7 <br /> 1 G 3 <br /> I <br /> W RiP 20, m <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Right-of-Way on <br /> the kie5S:r side of S. M^N"fF--c-.a• R.on'D approximately Moo L-:(RMile of <br /> of W. X-1 Po t) g o. , by performing the following work(description of work): <br /> -Ta (ZENIoy F- Atic> 2{3eo# LIWE F- FeJF-T of �IaG•1•F. P. <br /> W I-TH 441?;' C-L-AS-ts, _F1C-1Rc-,P and WO-s-T -910P— a l� S. MA 1 fT ec.A tZ� <br /> F-)Pe . kjF_ IS Loc.+�-i APFR~mC. IS �-T• o�TS�rJt� cSP- f2-Ic�H?' -off -I..�nY• <br /> Work will commence on or about M i C> N O V EM 95g;= - for approximately 14- 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 /> T.� 1c;k <br /> Signature of Applicant-Title Date <br /> E:VPUB-SV.WKWMTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />