Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 6-02-10 <br /> To: San Joaquin County-Highway Department OFFICE USE ONLY <br /> JOB#1999== REF # <br /> PG&E APN _- - CRV# <br /> (Applicant Name) EXP. DATE - <br /> 1524'.N. CARPENTER RD. VALID6-T "`� DRIVEWAYS: <br /> 'eW(Mailing Address) STREET <br /> AREA �g UAD <br /> MODESTO. CA. 95351 _ TYPE FORMS <br /> (City, State,Zip Code) NOTE <br /> 209-576-6603 <br /> (Area Code—Telephone Number) --- <br /> Sketch (Detailed plans may be submitted) <br /> i <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on <br /> County Highway Right-of-Way on the N/E side of Santa Fe Rd._ approximately 80 <br /> feet/mile _N__ of _River Rd., by performing the following work: (description of work): <br /> _Excavate 4'x4' of <br /> for valve maintenance <br /> 15 <br /> Work will commence on or about 6/28/10 for approximately '2, - days. <br /> I the undersigned certify that I am the owner of the respective property, or am qualified to represent the <br /> owner agree to do the work described above in accordance with the rules, regulations of San Joaquin <br /> County and subject to.inspection and approval. <br /> IG URE OF APPLICANT—TITLE DATE <br />