Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date g t,02 z o�k OFFICE USE ONLY <br /> To: San Joaquin County JOB# 99:CW,�Z--1 5 REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE <br /> VALID /o TO DRIVEWAYS: <br /> 4( pplicant Name) STREET <br /> AREA TYPE �_ A"/QUAD <br /> —(M(Il bailing Address) FORMS <br /> NOTES <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway R� � <br /> Right-of-Way on <br /> the side of I,LX�2yF�rrZ/L�. <br /> AY <br /> of ,E �oAn approximately _ /p r--C_mff <br /> _ Y Qo�d� by performing the following work(description of work): <br /> Work will commence on or about for approximately days. <br /> I,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 above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> . <br /> of Applicant-Title Date <br /> t7Signlire <br /> .SIENCROACHMENT PERMIT APPLICATION.DOC (01") <br />