Laserfiche WebLink
APPLICATION FOR $NCROACENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB # fl�Jr REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE <br /> VALID' �I��D o 6 TO DRIVEWAYS: <br /> (Applicant Name) STREET t>,&Jr . <br /> AREA ST4c WTo+4 QUAD AE <br /> 1'� �/giy �/ 1S�C11 �11rc TYPE y CV Q Clark CA <br /> (Mailing Address) FORMS <br /> NOTE <br /> (City, State, zip Code) <br /> ea Code —Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to.excavate, .construct and./or <br /> otherwise-encroach ori .-County Highway Right-of-Way-on-the/ k-!it6 side.:of- <br /> ' rZ;V�wP� approximately ��-/S feet/mile Chi r-RW/<Fl <br /> of wSSG`.�c, _ . <br /> , byperforming the <br /> followin work (description of:work) : <br /> Work will commence on or about for approximately <br /> days. <br /> I, the undersigned certify that I am the owner of. 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 /> Signature of A licant Title <br /> P� Data - <br /> ITER-FS "MCB L (6/00) <br /> i <br />