Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> M <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB0 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE -?I <br /> 6 VALID 1-/Zl/i TO <br /> DRIVEWAYS: <br /> (Applicant Name) STREET WCA(i <br /> AREAL _ <br /> r TYPE <br /> (Mailing Address) FORMS 5. WJ41 <br /> NOTES <br /> E iv. <br /> (City,State,Zip C6de) <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 <br /> approximately feet/mile <br /> of &L.'..4-e' by performing the following work(description of work): <br /> Work will commence on or about x" for approximately------ days. <br /> ­ <br /> 1, 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 ppicant-Title Date <br /> PETWIT X'N.C.411XI DC' <br />