Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# _ <br /> Department of Public Works APN CR# _ <br /> EXP. DATE g- _ <br /> VALID TO / p19 DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA QUAD 06- <br /> TYPE AGES <br /> (Mailing Address) FORMS <br /> ,d NOTES ;lv/I�i✓//1/ ' <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 /> thet P ' " side of approximately L1 j?-{S feet/mile <br /> of by performing the following work(description of work)42 : <br /> Work will commence on or about r for approximately_/ days. <br /> —. Y <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 /> r <br /> Si ure of Applicant Title �J,�1 Date <br /> E.1PU&SVWMMAS R.PS�ENCROACHMENTPERMIT APPLICATION.DOG (01108) /''I <br /> �-h1•t.%;• p�or1BS,��I�'i'a�,/Go»,Com <br />