Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> k L l..�.� '-:7 4 <br /> PLBASE PRINT: SAN )0F! 0JHTY <br /> QAAc <br /> Date May 8, 2006 OFFI p <br /> DEPT. OF PUBLIC 'nt0RKS <br /> To: San Joaquin County JOB # REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE 46(40 <br /> Gerald Ford VALID '23 a TO DRIVWAYS: <br /> (Applicant Name) STREET 477- <br /> AREA QUAD <br /> P.O. Box 902 TYPE <br /> (Mailing Addreaa) FORMS <br /> NOTE <br /> Linden, CA 95236 <br /> (City, State, -Zip Code) <br /> 209-887-1890 <br /> (Area Code - Telephone Number)_ <br /> Sketch (Detailed plans may be submitted) <br /> See Attached <br /> -� Ma„A +ain +(4pi c. Co,,+t,I s �.,r 0.1( roacbS. /I wz,- y. � sAA1 @t <br /> /o- �Zrr►.� ww ,v� l�eu✓s� fwv-way /af 4 cd t7/ia/ sA n-ra�AoeaiAecl <br /> �,�� e,�., l�►u �► � �pp►�pr�a�P �lo.�q��s . <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise-encroach on County Highway Right-of-Way on the North.. • side..of <br /> Front Street approximately 200 ee /mile West <br /> of Mill Street L�.vDE.t/ .. . by "per€orming the <br /> following work (description of work) : Install two sanitary sewer stubs to an <br /> existing building. Backfill and patch asphalt concrete as necessary- , <br /> Work will commence on or'about May 16, 2006 for approximately <br /> 2 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 /> SU�aiatu'_re f Applicant - Title Date <br /> 14STWt.P3\FnSCHDL (6/00) - <br />