Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB # REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE .07 <br /> VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET 9V-0— * <br /> AREA UAD <br /> L! <br /> TYPE -rf <br /> (Mailing Address) FORMS nVW1"'/ <br /> NOTE <br /> (City, State, Zip Code) <br /> (Area Code Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> L <br /> The undersigned hereby applies for permission to excavate, constri;ct and/or <br /> ot er ise encroaq)� on County Highway Right-of-Way on the `ti-'t' :T'C side of <br /> )I! approximately f e'/mile <br /> of by performing the <br /> fo}lowiyg work, (description of work) ",)-,,2-. <br /> i-)T 16' <br /> 44, <br /> Work will commence on or about <br /> 1 for approximately <br /> - C 11 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 /> -7, <br /> V <br /> Signature of ApplIcint Titl/6 Date <br /> MASTER.FS'FE6S(:1,-,L (6/C0 <br />