Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# �,3j,��� /7 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID / T DRIVEWAYS: <br /> (Applicant Name STREET Z>, <br /> AREAQUAD <br /> TYPE 7&1Joq XW <br /> (Mailing Address) FORMS <br /> NOTES5v- WO 2WMAeWr <br /> (City, tate,Zip Code) <br /> -2 :2 3 5 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate, onstruct and/or otherwise encroach on County High Right-of-Wayon <br /> the side of approximately f fe" mile <br /> off , by p rforming the following work(description of v�ork <br /> re- <br /> %f t l:. <br /> t ! c r'oss <br /> • &2l ' <br /> Work will commence on or about .0for 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 /> � � r <br /> Signature of Applicant-Title Date <br /> E:IPUBSV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />