Laserfiche WebLink
t-KU1.1 •t:HL 11-UKIV I H WH I tK btKV l Ut 1-HA .NU. -GF974b4VJ 17J. aep. ze �YJVJt3.'FD4-G-zsr I:t•' G <br /> ApPI„TCATTON FOR ENCROAC84ENT PERMIT <br /> a� OPPICH USE ONLY <br /> Da' <br /> .TOE # 4 REF # <br /> To: San Joaquin County JOB # <br /> Department of Public Works RXp. <br /> ' DAx <br /> vALID <br /> o a'� <br /> aIWAY9=CAUTO?Mh <br /> (Applicant Name) sT <br /> + <br /> AJM 5-M QUAD _ <br /> � O W •'F��.'Mot1T' Sr t-\CEJ TYPE <br /> RM <br /> ,� <br /> (Mailing Addreelg) VO <br /> SkMWCoV CQ 10Z 1@10 3 NOTE <br /> (city, 9batte, .rip Code) <br /> (Area Code - Telaybone NUMber), <br /> Sketch (Detailed play may be submitted) ' <br /> 8J�1Z ; <br /> The undersigned hereby,applies for permission to.excavate ons uCt and/or •• <br /> otiaeri.sa•encro c -on county..Highway Right-of-Wa •os•t sidp..of , <br /> p approximately <br /> of <br /> llowing wor u (description of work) : <br /> r <br /> Wox wi17. commence on or about fox approximately <br /> days. ' <br /> Z, 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 appro v-zl.\`O� <br /> ant x tle <br /> Signature of Applic - nate <br /> ►o�.as�satacrms cs/oof .. . , <br />