Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> P - 00 07 <br /> Date 319115 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE: -161 <br /> - <br /> Morada Produce VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET 6-P fid( <br /> AREA Lmo6e-0 QUAD /VE <br /> PO Box 659 TYPE Ke * <br /> (Mailing Address) FORMS //_" q <br /> NOTES <br /> Linden,CA 95236 <br /> (City, State,Zip Code) <br /> (209)546-0426 <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 east side of Jack Tone Road approximately 1600 feet/mile of Co ero)olis Road by performing the following work (description of <br /> work): <br /> To bore underneath Jack Tone Road and to install 12"waterline for agricultural irrigation. <br /> Work will commence on or about _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 a ce with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> ature of Applic -Title Date <br /> M:ICENTRALSERVICESIC PICALNUMV.WIOMASTERPS%ENCROACHMENT PERMIT APPLICATION.DOC (09/13) <br />