Laserfiche WebLink
APPLICATION FOR,ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date _7/ 1 // S OFFICE USE ONLY <br />To: San Joaquin County JOB#Z Z 1 REF#Department of Public Worlts APN CR# <br />EXP.DATE 1 S1Cl`0-5 VALID <br />APlalicant Name) STREET <br />TO /`/ DRIVEWAYS: <br />t <br />AREA — Q <br />TYPE <br />MaalingAddress) r-oRMs <br />NOTES <br />City,State,Zip Code) <br />Arca Cads Tel2phorre Numk Er) <br />Sketch(Detailed p(ans Tay be submitted) <br />seme <br />The`ude 'gned hereby applies r pe mission to ex avate,construct and/or otherwise encroach on County Highway Right-of Way onthe `^' side of <br />of ewer' approximately_`,()o % feet/mile <br />6y performing the following work(descript'on of work): <br />e, <br />V\ l fe <br />t>D\Q <br />Worlt will commence on ora t 7 for approximately 7 days. <br />I,the undersigned,cerfify that I am the owner ofthe respective property,or am qualified to represent the owner and agree to do theMdesc0edaboveinaccordancewiththerulesandregulationsofSanJoaquinCountyandsubjecttoinspectionandapproval. <br />A rSignareofApplicant-1 We <br />ate <br />UACEWrrwsEmnCE=BzMVU_V.1%1"ASTM PSGeAaCJENTrfw.o NftCarMDOC ro11y