Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date J (�c0 OFFICE USE ONLY <br /> To: San Joaquin County JOB # Z3)52,(o REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE S/ ` <br /> tel/ VALID !� TO / d DRIVEWAYS: <br /> (Applicant Name) STREET 111tC4A"j1D * <br /> AREA S7,-ie k'raAlQUAD <br /> TYPE Ae-!L 4,e —e2E <br /> (Mailing Address) FORMSWa...' le-29n ,ra NOTE- <br /> (City, <br /> OTE-(City, State, Zip Code) <br /> � !IA'z - I&lz� <br /> (Area Code - Telephone Number) <br /> �- N V) <br /> n 3iC <br /> et A (gtailed plans may be submitted) <br /> TRAFFIC CONTROL PLAN <br /> o SHALL BE AS PER <br /> c 4 CURRENT M.U.T.C.D. <br /> c CALIFORNIA SUPPLEMENT <br /> a <br /> N W <br /> Q <br /> PM� �SZ�✓3�- <br /> t o 102) o 0 <br /> The undersigned hereby applies for permission to excavateconstruct and/or <br /> otherwise encroach ,n County Highway Right-of-Way on the ��T `slide of <br /> GC. approximately feet/nom <br /> of G D �= , by ----P--ming the <br /> following work (des ription of work) : <br /> Work will commence on or about for approximately <br /> 110 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 /> I b( It'(oDL 6 <br /> r\FEESCHDL <br /> f Applicant - Title Date <br /> (6/00) RETLMN PEC��TO. <br /> Pft <br /> JOB PRMESSM DESK- BLD 1 <br /> 4040 MW t <br /> STOMMN, CA <br />