Laserfiche WebLink
i._., <br />• <br />PLEASE "mlllf: <br />Date 6 -?-,-2016 OFFICE USE ONLY <br />To:San Joaquin County <br />-Department of Public Works <br />P&1E PIM 3Ib6:2C(/7 <br />IAppiicalil Nama) <br />t-io LIe w -e.s,-+L,u\~ <br />(I\Jlllilirig t\!iIilress) <br />$t"t,k -+6 V\.•C-l'\q !i2.0 'f(Cily.S~ta.lip !Golie) <br />r;20~1)?'73 ~e:l'f .S"<..rxc-/2..<Eire;,&Ji,~' <br />~(Auea Code.relepl!orle i\lllillber) <br />Sketch (Detailed plans may be submitted) <br />JOB #1$qo:5(}~(,p <br />APN <br />EXP.DATE <br />VAliD <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />REF# <br />CR# <br />DRIVEWAYS: <br />.The undersigned hereby applies for permission 10 excavale,conslruct and/or olheilNlse encroach 0Q County High~Right.of.Way on <br />theU)side of,..--LIt't.1-t2rt4-Ave '.approximately l:::t 6 2..<fuetJlnile__!1L__ <br />of ".@ VIA 13;g))(f,R5>C A LOlili ,by performing the following work (description of work):, <br />«efta •...(t l>e:b.",•..1"0 r-a:t\vO A V"'_w~'\~~/_-_L~o~(!.~_ <br />Work will commence on or about 7-iB -:4(;)16 for approximately ~days.t:l'JJ>It-=a.b ~2..CJIt" <br />I,lhe undersigned,certify that Iam lhe owner of lhe respective property,or am qualified to represent lile owner and agree to do the <br />work described above in accordance with tile rules and reguiations of San Joaquin County and'subjectto inspection and approval. <br />AhvJ Dp~ <br />Signature of Applicallt.Tille <br />~t\cE/{JRALSElllilCESlClfRICALI!'U!l-SV.WK\MI\ST£ItPS\ENCROACffMENTPERMIT APPLICAnOIUiOC (~I13) <br />t;,-2'T-::a i)16" <br />Date