Legal Name of Business:
Business Address:
Business Phone: / Business Fax:
Contact Name:
Contact Phone: / Contact Fax: / Contact E-mail:
Legal Status: / Corporation / General Partnership: / Limited Partnership:
LLC / LLP / Other / Explain:
State of Incorporation/Partnership: ______
Project Description:
Project Cost within 50 feet of tracks:
Equipment to be used within 50’ of tracks:
Estimated Starting Date: ______
Estimated Completion Date: ______
Please forward project drawings that relate to JPB property
Forward this application to:
Peninsula Corridor Joint Powers Board
Attention: Aaron Lam, Engineering Department
1250 San Carlos Avenue, San Carlos, CA 94070-1306
(650) 508-7785 FAX (650) 508-7967, e-mail:
3rd Party Form Encroachment Form 7-11-07