Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: . <br /> Date ' /j� OFFICE USE ONLY <br /> To: San Joaquin County JOB # 7--6, REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE /z/ d8 . <br /> VALID. 41floq TO DRIVEWAYS: <br /> PG&E STREET <br /> AREAIe�QUAD _ <br /> 4040 WEST LANE TYPE � �� <br /> e ,� . <br /> FORMS �r�,Gd►!!/ fi'Z <br /> STOCKTON, CA 95244 NOTE <br /> (City, State, .Zip Code) <br /> �Zo°17 altl2- l�27 <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 ��fo� J <br /> NOTIF: 10--15o lr,�7?5-77 <br /> The undersigned hereby applies for permission to.excavate, qonstruct and./or <br /> otherwise <br /> e--/e�n�croach- o County 'Highway Right-of-way--on-the - � side..of <br /> kL�� approximately feet/mize n2Q:I�h <br /> of ' by - erformisl.g the <br /> followistrk__d� <br /> ( crption of: work <br /> Work will <br /> commence on or about O o for approximately <br /> 0 — <br /> 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 rules, regulations of San Joaquin County and subject to <br /> inspection and approval. ` <br /> /0 e) <br /> S ature of Applicant Title Date <br /> MASTM.PS\FSBS®L (s/oo) RETURN PERMITS TO: _ <br /> CCD <br /> PG&E <br /> P.O. BOX 930 <br /> STOCKTON,CA 95201 <br />