Laserfiche WebLink
mw�� <br /> ' APPLICATION FOR ENCROACBIJENT PERM <br /> FacE PRINT: <br /> pL ,w i <br /> Date <br /> - �4 O OFFYCZ ONLY <br /> To San Joaquin County JOB !l° o S- PIE? # <br /> Department of Public Works APN CR <br /> r EXP DATE S'/ <br /> VALID TO <br /> DRrvawAY3: <br /> (Applicant ame) STREET AlrSS/t?Y � <br /> c✓ / AREAGr-7?A1 Q s <br /> /.3�cv 5�/ C,Q�r1�r ST• TYPE O/vi To r - <br /> {Mailing Address) FORMS 5J w;✓ t. <br /> A160�l C' <br /> -eilK "f J Z211— �;ay 3 ROTE <br /> (City, State, Zip Code) <br /> -3 0)' G1(';' of�-- S�Oo <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) �/ t <br /> fT�G��/ r'•7 ��S <br /> ,5-,e e • <br /> u ,ji <br /> � � 9 <br /> a <br /> The undersigned hereby applies for permission to excavate, cost ct and/or <br /> otherwise encroach on County Highway Right-of-way on the kside of <br /> .o approximately • feet mile .5�2 c. Ali <br /> of r v' O h ra y performing the _ <br /> following work (description of work) <br /> e-ul 0.0 f.0or• �i�c^ <br /> r // �/Ol�.__ '0 <br /> h f��f <br /> r /G 7'7C7 <br /> r / r 11J� <br /> Work will commence on or about 024 O for approximately <br /> days <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> Inspection and approval. <br /> Lp � <br /> Signature of A lican Title Da o <br /> ruTme 1PG%FUnBC=L (4/30/001 <br />