Permits & Development - Encroachment(EP)/Driveway(DW) Permits - 2024_PS-2401001 thru PS-2401500_ - PS-2401055

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PLEASE PRINT: APPLICATION FOR ENCROACHMENT PERMIT Date '11 / 2 I Z o 7 -A To: San Joaquin County Department of Public Works (Applicant Name) (Mailing Address) (City, State, Zip Code) 9 7 `l -1l%o 0 (Area Code - Telephone Number) Sketch (Detailed plans may be submitted) DRIVEWAYS: The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County HighRight-of-Way on the &&4r' 4% side of ?6E Po\tt approximately 3 Wile of o e o e.:- l b r L , by performing the following work (description of work): Work will commence on or after 4 /Z I L for approximately '7 days. 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 work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. 4, Con %ozko r Ll 10 2 V Signature of Applicant - Title Date OFFICE USE ONLY JOB # 110005 REF # _ APN CR # _ EXP.DATE VALID 4/5/2024 TO 5/5/2024 STREET Bates Rd AREA QUAD TYPE Trench (dirt shoulder) FORMS SS/VWV R-29 NOTES Snerial Conditions DRIVEWAYS: The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County HighRight-of-Way on the &&4r' 4% side of ?6E Po\tt approximately 3 Wile of o e o e.:- l b r L , by performing the following work (description of work): Work will commence on or after 4 /Z I L for approximately '7 days. 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 work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. 4, Con %ozko r Ll 10 2 V Signature of Applicant - Title Date