Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date � / OFFICE USE ONLY <br /> To: San Joaquin County JOB # 25 J"5 Z."" REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE <br /> VALID. TO DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA �i�/(J' Q <br /> L <br /> l� TYPE !t Uz:E L <br /> (Mailing Address) FORMS <br /> `.) L 'NOTE <br /> (City, State, .Zip Code) <br /> (Area Code - Telephone Number)_ <br /> Sketch (Detailed planta may be submitted) <br /> TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D. <br /> ✓ CALIFORNIA SUPPLEMENT <br /> The undersigned hereby applies for permission .to.excavate, .co ,truct and/or <br /> otherwise-ecroach on County. Highway Right-of-Wa- -oa-the = ide. of <br /> approximately feet/jdmft <br /> of b -perfo 3. 9 the <br /> following work (d cription of wor ) : <br /> ' -- �Lw MeAdl" VC bib <br /> Wor will commence on or about for approximately <br /> days. <br /> I, the undersigned certify that I am the owner of. the re spective, 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 /> tSiature of Applicant - Ti� eDate <br /> ?'BBS®L (6/ 0) <br /> i <br /> i <br />