Laserfiche WebLink
M:\CENTRALSERVICES\CLERICAL\PUB-SV.WK\MASTER.PS\ENCROACHMENT PERMIT APPLICATION.DOC (09/13) <br />APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To: San Joaquin County <br />JOB # REF # <br />Department of Public Works APN CR # <br />EXP. DATE <br />VALID TO <br />DRIVEWAYS: <br />(Applicant Name)STREET * <br />AREA QUAD <br />* <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 />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br />the ______________ side of ___________________________________ approximately ___________________ feet/mile _________ <br />of _______________________________________, ____________________, 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 />Signature of Applicant - Title Date <br /> <br />Signature of Applicant -Titltltlttltltltltttltltltlttltltttttttttttttttttttttttttttttteeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee <br />work described above in accordance with t <br />Engineering <br />Administrator 09/12/2022 <br />$(4- <br />AT&T CALIFORNIA - VALLEY PERMIT DESK <br />1445 VAN NESS AVE <br />FRESNO, CA 93721 <br />(559) 552-4608 g26977@att.com <br />09/12/2022 <br />$&23<2)7+(75$)),&&21752/3/$1,668%0,77(':,7+7+,63(50,7 <br />6(($77$&+0(176 <br />NORTH LOCKE RD <br />MAIN ST (CA-88) <br />3,769 S/W <br />THE ASSOCIATED TCP IS SUBMITTED WITH THIS PERMIT. PLEASE SEE THE ATTACHED <br />DIG (3) 4'X4' PITS, PLACE (1) NEW CMPH, PLACE 68' 1-4" DUCT VIA BORE IN DIRT. <br />PERMIT DRAWINGS FOR AT&T JOB# A02EQJ7.