Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date G'� OFFICE USE ONLY <br /> To: San Joaquin County JOB ## 1 3JS'"-( REF # <br /> Department of Rublic Works APN CR # <br /> EXP. DATE "]-1-D8 <br /> VALID i- 1 --,Qa TO ' -U DRIVEWAYS: <br /> PG&E STREET <br /> AREA S I GC:Ic v?� QUAD <br /> 4040 WEST LANE TYPE lL f/& T x'H <br /> FORMS <br /> STOCKTON. CA 95204 NOTE <br /> (City, State, Zip Code) <br /> CZo�17�ltl2- t�2� <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> SEE ATTACHED SKETCH <br /> PM �q <br /> NOTIF: <br /> The undersigned hereby applies for permission to-excavate, construct and/or <br /> other 'se enc oach on 11-14, County Highway. Right-cf-Wa:y-ox-the side-"of <br /> approximately _ feet/wd=t;e ® <br /> Of ' ` , by performing the <br /> r <br /> _ fo lowing work—(description of work) <br /> Work w'll commence on or about 4 for approximately <br /> d days. <br /> I, the undersigned certify that I am the owner of the respective, property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rule=s, regulations of San Joaquin County and subject to <br /> inspection and approval. y <br /> S ature of Applicant •- Title O _ tDate <br /> MASTM.PS\FMS®L (a/ao) RETURN PERMITS TO: <br /> CCD <br /> PG&E <br /> P.O. BOX 930 <br /> STOCKTON,CA 95201 <br />