Laserfiche WebLink
' APPLICATION FOR ENCROACHMENT PERMIT <br /> tPLEASE PRINT: <br /> Date 12/3 20J <br /> - OFFICE USE ONLY <br /> To: San Joaquin County JOB# //OGS REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE ziid— <br /> VALID Ty, S�2ad9T0 Tan. /S,�.e9 DRIVEWAYS: <br /> t��T (Applicant Name) rr STREETe�#.. j. <br /> IT'D '��iJol��n� 40- b75 AREA b, QUAD Sw <br /> ' �^ TYPE <br /> (Mailino Address) FORMS 5 -z- <br /> 00 00 <br /> �10,� Cf1- 940-7 NOTES <br /> (City,State,Zip Code) <br /> 5-10 -4(L--71 L 8' <br /> ' (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> ' See loco"f< v-t <br /> ' The undersigned hereby applies for permission p to xcavate,construct and/or otherwise encroach on County High Right-of-Way on <br /> the C�5?'- side of �✓e)�y �� <br /> of i� ,t I�� .,, --� approximately lop Bile _ <br /> ' Ver I C!� by performin the following work description of work): <br /> S C 1 J a I o r%tel, 1 %:, ci ti of v � <br /> W I l ZCf J i{ �, "uitsti <br /> �v li/pl tt )Z ✓in i J 11 <br /> Work will commence on or about 'S_a�x,��,�r� �pc�q 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 /> worts described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signature of Applicant-Title �� <br /> ' Date It, <br /> E!Plrq-SV.YlKMASTER.PS>FNCROAC4NENTPEFUTAPPLiCATON.000 (010) F <br />