Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date _h9_',,4 7 OFFICE USE ONLY <br /> To: San Joaquin County JOB # I/ REF # <br /> De artment of Pub is Works APN CR. # 0 x:52 <br /> EXP. DATE <br /> r� VALID d- -O TO f407 DRIVEWAYS: <br /> I ( plicant Name) STREETUIl41DG��17 <br /> AREA W!!Ct ��/QUAD <br /> TYPE 5'lA2E�l'Gi9/J�� ECGi'.yy/�p� <br /> R (Mailing ddress) FORMS <br /> NOTE <br /> (Ci State, Zip Code) <br /> l� <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate, construt and/or <br /> otherwise e croach on ounty Highway Right-of-Way-on-the <br /> Sid o <br /> 1 approximately , eet/mile <br /> of , <br /> following wor (descri t n of ork) : �' by performing the <br /> Work will c m_ence on or about <br /> @� ,-days-_ for approximately <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 n s p e c t i o n7 drapprovtTl. <br /> Signature of Applicant' .- Title — <br /> Date <br /> MASTER.PS\FEESCHDL (6/00) <br />