Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT„ <br /> Date 7,�!5 /j OFFICE USE ONLY <br /> To: San Joaquin County JOB# / ,y REF# <br /> Department of Public Works APN CR# <br /> /J� EXP.DATE y <br /> 2 � VALID / DRIVEWAYS: <br /> (Applicant Name) STREETXAQUAD <br /> AREA _ <br /> �}7(� �^ lu TYPEl�.0� �id/ 5- 2r6d/.rZs <br /> (Mailing Address) FORMS <br /> 5� <br /> NOTES <br /> ��- -7!5 <br /> (City,State,Zip Code) <br /> 9-#-£ - 7f <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the boA_side of I"eLj WeeA -,/,r approximately feetimile <br /> of by performing the following work(description of work): <br /> W ig e/,j, -nx Jn ,/76" c So-�' Jo'c <br /> .-44J er oce ,-e <br /> a�►r,( cte <br /> ,, dray <br /> Work will commence on or about / l/ for approximately days. <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> nature of A plicant-Title Date <br /> E. TERPSIENCRQ%CNMENTPERIATAPPLICnTIONOOC(01eq <br />