Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRI <br /> Date 2S OFFICE USE ONLY <br /> TO: San Joaquin County JOB # REF # <br /> Department of Publ'c Works APN W-091-e20 CR # <br /> EXP. DATE r <br /> VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET _ir,(NcLAtR. <br /> AREA stocTorl> QUAD <br /> TYPE � <br /> T <br /> (Mailing Address) FORMS AO-Z-7 <br /> CACA <br /> NOTE <br /> C <br /> 'A <br /> (City,S�Statte, Zii'p') Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to .excavate co struct and/or <br /> o <br /> he -encroach on County Highway Right-of-Way ori-the de. Of <br /> approximatelyfeet mile <br /> of 1 _ y performing" the <br /> fQ11owing work (de cription of work) : <br /> Worc will commence on or about 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 /> i pection nZap oval. + <br /> Signature of Apn2lclt - Title Date <br /> MASTER.PS\FESS®L (6/00) <br /> 1 <br /> i <br /> 1 <br />