Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 03/22/2024 <br />To: San Joaquin County <br />Department of Public Works <br />Learn <br />(Applicant Name) <br />4907 Griffin Rd, <br />(Mailing Address) <br />Ca, 95326 <br />(City, State, Zip Code) <br />209 531-3895 <br />(Area Code - Telephone Number) <br />Rory@leambackhoe.com <br />(Email Address) <br />may <br />Plan is attached <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />110005 REF # <br />CR # <br />4/1/2024 TO 5/1/2024 DRIVEWAYS: <br />Cottage Ave. <br />QUAD <br />Trench (dirt shoulder) <br />SSMNV, R-29 <br />Special Conditions <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the East side of cottage Ave approximately 121' feet/mile <br />of E Southland Rd Manteca by performing the following work (description of work): <br />Runninq residential electric service for 15770 Cottage Ave. <br />Work will commence on or after 4/1/24 for approximately 2 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 />03/22/2024 <br />Signatur of Applicant - Title <br />V]FORN6&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />Date <br />