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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date <br />To: San Joaquin County <br />Department of Public Works <br />State, Zip Code) <br />.iDiII�I►_IiilT�il <br />� Sketch (Detailed plans mai; be submitted) } <br />��- AI icy. AWS <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County. Highwa Right-of;Way o <br />the � side of ���;i,`�fll (�f � approximately '°�`� ee mile ��� <br />of � �� Ll`Up �VGk PN , by performing the following work description of work): <br />Work will commence on or after <br />for approximately <br />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 ab�e in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />Wall I <br />Signat re of App i ant - Tit a ate <br />Y.VORM58 TEMPLATE&ENCROACHMENT PERMIT AP CATION.dm(08108) <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County. Highwa Right-of;Way o <br />the � side of ���;i,`�fll (�f � approximately '°�`� ee mile ��� <br />of � �� Ll`Up �VGk PN , by performing the following work description of work): <br />Work will commence on or after <br />for approximately <br />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 ab�e in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />Wall I <br />Signat re of App i ant - Tit a ate <br />Y.VORM58 TEMPLATE&ENCROACHMENT PERMIT AP CATION.dm(08108) <br />