Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT 2D16fiil.R-:3 .~H 8:0 I <br />PLEASE PRINT: <br />Date 3 -X--/{O <br />.OCr:'"(',~)~.FU2LJC V/ORKS <br />OFFICE USE ONLY <br />To:San Joaquin County <br />Department of Public Works <br />SEf'f,)CtJ!C-f./£!)!>pear <br />I (Applicant Name) <br />5<./(/INO{.l5TltJJlt...PAIZt.-l)l. <br />(Mailing Address) <br />MIJ1JTG-C,4I C.,(J q5"3_3_7_ <br />(City,State,Zip Code) <br />(Area Code.Telephone Number) <br />JOB #IIrJJdb . <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />"/6M!;1j{ <br />t/.{2t~.(-0 <br />l.Ie(f.:i:~.:;::'._<.. <br />REF# <br />CR# <br />Sketch (Detailed plans may be submitted) <br />The und,IJrsigned hereby applies for permission to excavate,construct and/or otherwise encroach on County High~Right-of-W':X on <br />theE&0 sideof E.:r.4c..~70,"'&7l-):;..approximately 700-~mile EiJ5-1 <br />of HI t;;.NwAY 8''?,L.Oc..?Ei(oriJ),by performing the following work (description of work): <br />Bo'flJ3;F12..0M &'XtS.TI,vb "761>1$'S1"i4L ON tJ.UIH;BE;~T ,,.uV ToT\-IE;BA<::i:Ob"I <;S'7iOl...HWY S'!uvS,TIJLL 1-2"c..OI->'DUIT fo£.. <br />CA Tv S,B/l.v\C,G.. <br />Work will commence on or about q-9-1&for approximately I.{5 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 />rt-efl11 T {)1oFt;/)II>/,A7ce <br />ture of Applicant -Title <br />M\CENrnALSERVICESlCLERICAl\PUB-SV.WKlMASTERPSlENCROACHMENT PERMIT APPLICATION DOC (00/131 <br />3 -8-}fo <br />Date