Laserfiche WebLink
APPLICATION FOR ENCROACMMENT PERMIT <br /> PLEASE PRINT <br /> Date ` a OFFICE' USE ONLY <br /> To: San Joaquin County JOB -(P REF ## <br /> Department of Public Works APN CR ## <br /> EXP. DATE i<.O <br /> VALID '7!93'093 TO DRIVEWAYS: <br /> PG&E STREET ,-eo ,O� • <br /> AREA QUAD <br /> 4040 WEST LANE TYPE �,�►'�� <br /> FORMS <br /> STOCKTON, CA 95204 NOTE <br /> (City, State, Zip Code) <br /> �Zor17�!2- t�27 <br /> (Area Code Tele h ne Number) <br /> Sketch (Detailed plans may be submitted) <br /> TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M,U.T.C.b. <br /> CALIFORNIA SUPPLEMENT <br /> SEE ATTACHED SKETCH <br /> PMoG�r..- 5Z 7 <br /> NOTIF: I p-P <br /> The undersigned hereby applies for permission to-excavate, ons. ruct and/or <br /> of ie wise-encr ch on County Highway Right-of-W2 os. the . ide of <br /> approximate) feet/nye <br /> Of by erform nq the <br /> followin _�rark._�d cri _to „of=work) <br /> Work will commence on or about for approximately <br /> — <br /> days. <br /> I, the undersigned certify that I am the owner of. the re spective, 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 /> Z <br /> S ature of Applicant - Title Daae ' <br /> MASTM.PS\MS®L (6100) RETURN PERMITS TO: <br /> CCb <br /> PG&E <br /> P.O. BOX 930 <br /> cTnrieTnni re aRin, <br />