Laserfiche WebLink
APPLlCA.TION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date <br />11003 E.kAFAV ETIE oT' <br />(Mailing Address) <br />DRIVEWAYS: <br />OFFICE USE ONLY <br />1@77 REF# <br />CR# <br />0~d..ez,e+-'J}{P.' <br />To:San Joaquin County JOB # <br />Department of Public Works APN <br />\,!.EXP.DATECALIEC)f2f\)}A 'vv A TERc)Erlll10..-E .VALID <br />.(Applicant Name)STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES~,sTaC-k.-TON 01 95<9-05 <br />(Cily,State,Zip Code) <br />'dDg~I-j iD Lj -B;3/! <br />~(Area Code.TelephoneNumber) <br />Sketch (Detailed plans may be submitted). <br />The un~~d hereby applies for ermission to excavate,construct and!or otherwise encroach 0n County Hi .Right-of-Way on <br />the...,~\',side of •-l.."•.t,approximateIy __~I fee ile lIk0Ih <br />of /J ":,,,nJ.,..,.o&-6 .,.,by performing the tollowing work (esCriptionof worfe):l~;f;fjYB£;:d;ff~(l()\)liJ~.~;i(x2)'r;lolooO <br />Wanewill commence on or about ..2J.\,~r aqpr1xima~IY days. <br />SIllSI,the undersigned,certify that I am the owner of the respective property,oram q alited to rep sent 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 />1.l:\CEmlW..sERlllCES\Cl.ffilCAL\PllB-SV.WKl!,IAS1ER.PS\E~'CRDACHMENT PERMIT APf'LIGATlDltDOG (09/13)