Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br />,( <br />PLEASE PRINT: <br />Date "t//(,II'- <br />To:San Joaquin County <br />Department of Public Works('-e <br />(Applicant Name) <br />4rJ.1o WGr*LtU <br />(Mailing Address) <br />~~~qSLJ:J.et <br />(City,State,Zip Code) <br />C/O'*'-y,,--11{.7 <br />(Area Code -Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />OFFICE USE ONLY <br />JOB#7~OOfZ.REF# <br />APN CR# <br />EXP.DATE 6-1£-1'.VALID 3-8-(b TO (,-1$-((,DRIVEWAYS: <br />STREET ~fHe • <br />AREA $\11 •r.m')L QUADTYPEflfi#!t (00/• <br />FORMS <br />NOTES <br />" <br />I <br />The <br />the <br />of <br />'gned hereby applies for permission to excavate,cons\ruct and/or otherwise encroach on County Highway Right-of-Way on <br />.side of ?--avy&..i •.•,approximately \;'\~t1mile tM1J- <br />v.,e {oc"'1 'by performing the following work (description of work):rlA:,""l'~-":ILl b J4<,..Jo II.....6-">Nl.<.j,,, <br />Work will commence on or about 01..~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 describe ve 1 ccordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />CWte/lb.Date