Laserfiche WebLink
i <br />Date <br />PLEASE PRINT: <br />6-?-1-20i6 OFFICE USE ONLY <br />To:San Joaquin County <br />-Department of Public Works <br />Pf::de.PIM 3106 '2C{[7 <br />lAllplic~lit li~tjll1el <br />[,..lo~lo Wes.+LOJ\.€... <br />lI\n~iiil1!ilAillilress) <br />$t "tJk -.f ()t\.•C-;'\ea !i2..0 I((City,St4le,-Zip Coole) <br />f?(J~h!73~1'f3<..rxcht2frB. <br />~(J\m~Code -I eil!phorul!rJ!!Jil1!ll!r) <br />JOB #'ljx6J.-G <br />APN <br />EXP.DATE <br />VALID. <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />REF # <br />CR# <br />DRIVEWAYS: <br />S~"'5 {,,,,,:a.-I-/1YlS ' <br />Sketch (Detailed plans may be submitted) <br />.The undersigned hereby applies for permjssion to excavate,qonstruct and/or otherwise encroach on CountY,Highway Right-of-Way on <br />the ,lEE side of $':t<.:ia'cv~4LRd.approximately'2 tt./7J ~ile .5 <br />of C)1U e n Go gA ,gent.all ),by performing the following worK descrfption of work):., <br />days•.for approximately <br />6ISd>.f~rW\. <br />/7~# <br />~efl tl ee.De;tl$I'lb r--a;te& <br />fffj-;2 .,J /"e \(jJ/f6 i'd..-fr,. <br />Work will commence on or about 7-t B -::?-C)16t==f'.lJ>H-:til -2.0 It' <br />I,the undersigned,certiiY that I am the owner of the respective properly,or am qualified to represent the owner and agree to do the <br />work described above in accordance wilh the rules and regulaiions.of San Joaquin-County and subjeciio inspection and approval. <br />/ <br />fV!w.J Dc~ <br />Sigfiat!Jre of Applicanl-Title <br />&.-:2..7-~()1-6 <br />D~!e <br />!,t\CEiIIRAL~R\.~CES\Cl.EHfC!l/JPUB-SV.WK\\.tAS1ERPS18jCROACfW.s~T PERMrTAPI'LICATlmHlOC (WI3)