Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date (!)t//(,I/'" <br />To:San Joaquin County <br />Department of Public Works <br />P6-e <br />(Applicanl Name) <br />4t1-1D WGt+-LJV <br />(Mailing Address) <br />~Q.1i+'iSLo<f <br />.(City,Slale,Zip Code) <br />'101t'-Yc...,1"7 <br />(Area Code -Telephone Number) <br />OFFICE USE ONLY <br />JOB#7500£2-REF#APN CR#EXP.DATE 6-/$-/6VALID'S-fJ-i6 TO 6-{>-fb DRIVEWAYS:STREET ~rd •AREA I'rts QUAD A/G •TYPE •eltba1eFORMSSSM/V &>9NOTES <br />Sketch (Detailed plans may be submitted) <br />The undersigned hereby applies for permis~on to excavate,cons(ruct and/or otherwise encroach on County Highway Right-of-Way on <br />the f::c.?.\-side of AJ">y >1-approximately 4-.r-@/Wmile 5f"b" <br />of ft.ibr ,=cl~'-!M-tA--._-.l-s-,by performing the following work (descriplion of work):'"'T -U -z..l ~ <br />days. <br />Cfl/!fa/!b <br />Dale <br />for approximateiyWorkwillcommenceonorabout0(..~ <br />I,the undersigned,certify thaI I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br />work describe ve i ccordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />E:lPUll-sV.\\'KIJIASTERf'SIENCROACHMEtrr PERMIT APPUCATlON.DOC {Ollila}