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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 DRIVEWAYS: <br />(Applicant Name)STREET * <br />AREA QUAD * <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 />$7 79&&3(50,76'(6. <br />(2/,9($9( <br />)5(612&$ <br />  J#DWWFRP <br /> <br />$&23<2)7+(75$)),&&21752/3/$1,668%0,77(':,7+7+,63(50,7 <br />6(($77$&+0(176 <br />($67 .,1*6/(<5' <br />$&&(66%$55(/9$8/77263/,&((;,67,1*),%(5&$%/(7+($662&,$7('7&3 <br />0$5)$5*2$5' <br />6287+ <br />,668%0,77(':,7+7+,63(50,7)25$7 7-2%$99+ <br />July 7, 2020 July 13, 2020 <br />Engineering <br />Administrator 6/17/2020 <br />Duration: 3 Days