Laserfiche WebLink
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 />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on &ounty Kighway ULght-of-Zay on <br />the ______________ side of ___________________________________ approximately ____________ feet/mile _________ <br />of _______________________________________, ____________________, by performing the following work (description of work): <br />Work will commence on or after _____________________________________ 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 />1/3/23 <br />PACIFIC BELL TELEPHONE COMPANY DBA AT&T CALIFORNIA/VCC PERMIT DESK <br />1445 VAN NESS AVE <br />Fresno, CA 93721 <br />(559) 552-4608 <br />g26977@att.com <br />SEE ATTACHED TCP DRAWINGS FOR AT&T JOB #A02HH3N <br />EAST BRUELLA RD 95 NORTH <br />E ORCHARD RD <br />RAISE LID OF EXISTING SB 806 TO GRADE. <br />1/31/23 1 <br />Dion Garza Digitally signed by Dion Garza <br />Date: 2023.01.04 12:50:05 -08'00'1/3/23