Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# ' JCS` REF# <br /> Department of Public Works APN _ CR# <br /> r EXP.DATE r$_ ,_— <br /> VALID - TO .Q`-1�,, DRIVEWAYS: <br /> (Applicant Name) STREET s, <br /> AREA �1-1.9 QUAD Al ' <br /> Y TYPE !� <br /> (M ." f V <br /> aili g Address) FORMS 1� <br /> NOTES <br /> C y3 1✓ � <br /> City,St e,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be s gym`tttteri) <br /> isloopS <br /> 7 <br /> The un ersi ed hereby applies forermission tox avate, construct and/or otherwise encroach on County Hig ight-of-Way on <br /> the s S side of O-Kk approximately �7_h' ?fe%eile <br /> of by performing the following work( escription of work): <br /> Work will commence on or about for approximately dayA. <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 /> S- re of Applicant Title - Date <br /> E IPUB- STER.P&ENCROACHMENT PERMIT APPLICATION.DOC (01MB) <br /> r <br />