Laserfiche WebLink
m)PLICATION 'FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ��� 4 �$ OFFICE USE ONLY <br /> TO: San Joaquin County JOB # I >2'25Z G REP # <br /> Department of Public Works APN CR - # <br /> EXP. DATE �0 15•oQ� <br /> VALID 1Z.1-0TO Co• 6.O$ DRIVEWAYS <br /> PG&E AREA <br /> sg _kt <br /> AREA 2-r'�cF_ QUAD <br /> 4040 WEST LANE TYPEFORMS <br /> STOCKTON, CA 95204 NOTE - <br /> (City, State, Zip Code) <br /> A2-- t x'27 <br /> (Area Code - Tele:nbone Number). <br /> Sketch (Detailed plan,, may be submitted) TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> SEE ATTACHED SKETCH <br /> P <br /> NOTIF: 1055Z t5'891$ <br /> The undersigned hereby applies for permission to .excavate, ona ruct and./or <br /> otherwise-encroac on (�ounty-Highway Right-of-Wa s-the side. <br /> approxof <br /> imately feet/ <br /> of AX,W -perfo he <br /> lowin nt criQ ion of wo ) :_ (1 <br /> - --- - <br /> Work will commence on or about for approximately <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 approvaa. <br /> l0 7 e <br /> S ature of Applicant - Title Date <br /> MASTM.PS\PEES®L (6/00) <br /> i <br /> } <br />