Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PSR KT:'` <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> VALID TO oDRIVEWAYS: <br /> --(Applicant Warne) STREET <br /> AREA QUAD <br /> TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> (City, State,Zip Code) <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 7' side of a <br /> approximatel <br /> of y <br /> feet/mile <br /> by performing the following work(description of work): <br /> Ak' X- <br /> Work will commence on or about about for approximately days. <br /> 1, the undersigned, certify that I am" rie'r of the respective property, or am qualified to represent the owner and agree to do the <br /> work described above in acc- �n ith the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> -Tignature or Applicant-Title <br /> Date <br /> EIVUBSV.VVKIMASTI-R.FSIENCROACiiM[-Nr PERMIT APPLICATION,00-- (01108) <br />