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Permits & Development - Encroachment(EP)/Driveway(DW) Permits-2021_PS-2100000 thru PS-2100500_-PS-2100407
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Permits & Development - Encroachment(EP)/Driveway(DW) Permits-2021_PS-2100000 thru PS-2100500_-PS-2100407
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Entry Properties
Last modified
1/12/2023 12:28:29 PM
Creation date
1/12/2023 12:26:48 PM
Metadata
Fields
Template:
Permits_Development
DocName
PS-2100407
Category07
Encroachment(EP)/Driveway(DW) Permits
Year2
2021
Notes2
Elmwood Ave.; Franklin Ave.
Address
6872 Santa Teresa Blvd., San Jose,CA
Application
ARCADIS
Type
Bore (over 12 inch Dia)
Supplemental fields
Cross Ref
PWP7110005
Type (2)
Encroachment Permit (EP)
Stamp
ID:
1
Creator:
Created:
1/12/2023 12:27 PM
Modified:
1/12/2023 12:27 PM
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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br /> <br />Date OFFICE USE ONLY <br /> <br />To: San Joaquin County JOB # REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE <br /> VALID TO DRIVEWAYS: <br />(Applicant Name) STREET * <br /> AREA QUAD * <br /> TYPE * <br />(Mailing Address) FORMS <br /> NOTES <br /> <br />(City, State, Zip Code) <br /> <br /> <br />(Area Code - Telephone Number) <br /> <br />(Email Address) <br /> <br />Sketch (Detailed plans may be submitted) <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <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 /> <br /> <br /> <br /> <br /> <br />Work will commence on or after _____________________________________ for approximately ________________________ days. <br /> <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 /> <br /> <br />Signature of Applicant - Title Date <br /> Y:\FORMS & TEMPLATES\ENCROACHMENT PERMIT APPLICATION.doc (08/08)
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