Laserfiche WebLink
APPLICATION FOR ENCROACHMEIITT PERMIT <br /> PLEASE PRINT: <br /> Date -- <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB #_73�Z_(p REF <br /> # <br /> Department of Public Works n <br /> C <br /> PN R' <br /> EXP. DATE <br /> VALID .J�(_I0 _ TO <br /> (Applicant Name) <br /> STREET <br /> DRIVEWAYS. <br /> AREA ., QUAD y, <br /> TYP #G $ORE(Mailing Address) <br /> FORMS ♦ Q ZQ <br /> n� NOTE -- <br /> (City, Sta. e, Zip Code) <br /> ------------ <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> o rn :5M <br /> n :P�rel <br /> ^0 .�rn <br /> rn <br /> p .. <br /> m Cn <br /> N <br /> C <br /> i <br /> The undersigned hereby applies for permission to excavate, c nstruct and/or <br /> otherwise encroach on County Highway Right-of-Wayon the �O UT/y� <br /> E '4Z-19 side of <br /> "��— approaimately feet/milt 6 <br /> of " , <br /> ollo n11 <br /> __, by performing the <br /> g o _ (description of work): <br /> j q �Xq � x9 ' Walt <br /> -- <br /> : i <br /> Work k yt1l�ill commence or,. or <br /> © days: for approximately <br /> I, the undersigned certify that I am the ownerof the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval_ <br /> i <br /> S ut cD - Ti ll- <br /> --'T�2'k'i.-Cant ... c <br /> Data <br /> MiS'T_2.85'•,FcESC�L ,;,�o,. RETURN PERMITS TO: <br /> PG&E <br /> JOB PROCESSING DESK -BLD 1 <br /> 4040 WEST LANE <br /> cTnr-KTnm rA 95204 <br />