Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE <br /> Date OFFICE USE ONLY <br /> To: San JUaquinCounty <br /> Department nfPublic Works <br /> .' <br /> VALID T6 DRIVEWAYS: <br /> (Applicant Name) S1 REET <br /> AREA QUAD —15�9 <br /> TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> (City,State, Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted') <br /> Theundersigned hereby appliesfor permission tnexcavate, construct and/or otherwise encroach onCounty Highway Right-of-Way on <br /> �Uo side of approximately feet/mile <br /> of . � . byperforming the following work(description� —�— <br /> Work will commence on or about <br /> days- <br /> 1,the undersigned, certify that I am the Owner of the respective property, or am qualified to represent the owner and agree to do the <br /> work described aoove ofSan Joaquin County and subject toinspection and approval. <br /> ''' <br /> Signature of Applicant-Title Date <br />