Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br />OFFICEUSEONLY <br />DRIVEWAYS: <br />REF# <br />CR# <br />I/I/OtJ6g53-S30-,97 <br />/1I/L>6nlwTifM,y <br />,/TO .L <br />/-&H.M.#N'~O. <br />~V QUAD :5W@A/~e~;Vrt'lbe/t#/A;~60rS.---/' <br />JOB# <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES/MeW:M 95304 <br />-(City,State,Zip Code) <br />02-RJ 1 J',?&I 6':P- <br />(Area Code,Telephone Number) <br />PLEASE PRINT: <br />Date _5&5/tUJ1~-7~---------- <br />To:San Joaquin County <br />Department of Public Works <br />7AIJ1I1M I1fM?t!bPaJllR./J5,-a;,cfvJ <br />(Applicant Name) <br />;1,PgtJ 2,P;tIMIPA/~O, <br />(Mailing Address) <br />Sketch (Detailed plans may be Sl '1mitted) <br />The undersig~ed hereby applies for permission to excavate,construct and/or otherwise encroaun County Highway f3jWt:£[:Way on <br />the 1f;AS7 sloe of a:ddf'A'A/I?tP/U>approximately ~~;;Vp:r# <br />of kNit/£-,ttLJAJJ ,flAOV ,by performing the following work (description of work): <br />Work will commence on or about for approximately tNL>£-6N'/7"6£Y.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 />~&.u::~~;~ <br />.Signature of Applicant -Title <br />Y:\FORMS &lEMPLATESIENCROACH.\AENT PERMIT APPLICATION,rloo (Oaro8) <br />CeLl j I~ <br />Date