Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 04/01/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> RICHARD KNIGHT XP.DATE 7- <br /> VALID TO -/S-gyp DRIVEWAYS: <br /> L (Applicant-Name) STREET <br /> y`� 5111�WC�lX�1f AREA .r QUAD _ \ <br /> TYPE <br /> (Mailing Address) FORMS 2 <br /> qs— ^Q� NOTES <br /> (Ci y,State,Zip Code) <br /> 925-242-0454 <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 NORTH side of E FUNCK RD <br /> of S WAVERLY RD approximately 420' feet/�i1e WEST <br /> FARMINGTON, CA ,by performing the following work(description of work): <br /> Replace Deteriorated Pole <br /> PM 31119161, Not: 109590422, Location 1 <br /> Work will commence on or about 07/10/2015 for approximately one 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 /> 04/01/2015 <br /> Signature of Applicant-Titf6 Date <br /> M:(CENTRALSERMCESCLERICALTUB-SV.WMMASTER.PS'6ENCROACHMENT PERMIT APPLICATION.000 (09113) <br />