Laserfiche WebLink
APPLICATION FOR ENCROACMCWT PMMTT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE OULY <br /> To: San Joaquin County JOB p # <br /> pN <br /> Department of Public Works REF # <br /> r._-,... <br /> Exp. DAT L •--! -- # <br /> r <br /> _-1 �- VALID. �._,� <br /> (Applicant Name) TO -fS _ DRyB: <br /> STREET <br /> IN AREA, <br /> TYPE �` <br /> QUAD � <br /> (Mailing Address) FORMS <br /> NOTE <br /> (City, State, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for <br /> - permission -vat <br /> e, construct and/orotherwise- encroach on County Highway Right-of-Way-.0a the <br /> approximately szre.oE.,. <br /> of eet .ff <br /> followz g work (description of work) : � a f by performing <br /> Work will commence 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, u <br /> regulations of San Joaqin County and subject to <br /> inspection and approval. . <br /> i Ure_of sJC'� <br /> - Title <br /> Date <br /> T&R.PS\FBSCf�L (6/001 <br />