Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date I v l <br /> FNOTE <br /> FFICE USE ONLY <br /> To: San Joaquin County <br /> Department of Public Works — ------ REF # <br /> CR # --__ <br /> EXP. <br /> p TO <br /> (Applicant Name) DRIVEWAYS:�s;�A/ SPD <br /> 1Q QUAD _(Mailing Address) 29� <br /> (City, State, Zip Code) <br /> (Area. Code - Telephone Number} <br /> Sketch (Detailed plans may be submitted) <br /> I <br /> The undersigned hereby applies for permission to excavate,. I <br /> Otherwise encr )ach on County Highway Right-of-Wayon the construct and/or <br /> side of <br /> of approximately feet/%jj:,. <br /> following work_ (description of work) by Performing the <br /> Work will commence on or about <br /> days. for approximately <br /> I <br /> I, the undersigned certify that I am the owner of the respective property, <br /> qualified to represent the owner and agree to do the work described above inr am <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> - - -inspection afid-�- <br /> pp-reua 1-�- _- ------- I <br /> l D� d I►(�10D�' , l <br /> Si ature of Applicant - Title <br /> Date <br /> f1AST .P \FEESCEM (6/007 <br /> AETURN��IT3 TO; � <br /> JOB PROCES&M DESK-MD 1 <br /> 4wo West Lar» <br /> CA 96204 <br />