Laserfiche WebLink
r APPLICATION FOR ENCROACHIMENT PERMIT <br /> PLEASE PRINT: <br /> Date g OFFICE, USE ON7_Y <br /> To: San Joaquin County <br /> JoB g ?3 0 5 2,- 49 RE F <br /> Department of Public Works FPN c n <br /> yy EXP_ DAT <br /> VALID � no' TO 1 l DP.IVEWAYS <br /> (Applicant Name) STREET Its MIN P-0%11� <br /> AREA Ttq2�.a CAWT QUAD S*G <br /> /6 41,0 (jLC.S% &illL TYPE -r&_iVGf/ iii,Lfo F <br /> (mailing Address) FORMS 4S 2W 7.9 <br /> NOTE <br /> eSTD.,`XM 1 4pq f_,5-.2D Y <br /> (City, State, Zip Code) <br /> (20 g -12- <br /> (Area <br /> 2(Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) ' TRAFFIC CONTROL PLAN <br /> .fit E /�Tl/4Lt1Ed S/�CEI'Ct/ SHALL BE AS PER <br /> CD « <br /> CURRENT M.U.T.C.D. <br /> 0 o CALIFORNIA SUPPLEMENT <br /> � 3 <br /> ts1 ace V <br /> Cn m <br /> 1� r n_ <br /> Pm 3o_52_341,51 <br /> C= <br /> a <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the side of <br /> w-11?iqls/ Rbapproximately 157 feet/ml-e I'h4, <br /> of P2/EST RD - e6,A/Pd /%4IW by performing the <br /> following work. (description of work) : <br /> Gxc cJrgT�' ,c3E[L A/D I L-.14s InogjAl m&-S z-AisT.4LL Li <br /> - <br /> TE[.GPNonIE ifAg 13E til/ t�l2 <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 /> S .�at-,=a of -_'=^ant - Title Date <br /> -�r�"y` RETURN PERMITS TO: <br /> t�STE2.PS••,FEESC-�L !6/00) <br /> JOB SSR-M DESK-BLD 1 <br /> 4W Vfte Largs <br /> STOCKTON, CA 95204 <br />