Laserfiche WebLink
APPLICATIOiX"FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT <br /> No <br /> OFFICE'. USE ONLY- <br /> Date <br /> To: San Joaquin County JOB #—L - REF # <br /> Department of Public Works . APN CR # <br /> EXP. DATE G <br /> VALID. TO -l -o g DRrMAYS: <br /> PC&E STiE$T - <br /> AREAV Q� <br /> 4040 WEST LANE TYPE �Y�� �A <br /> FORMS. CltOW <br /> STOCKTON, CA 95204 NOTE <br /> (City, State, .Zip Code) <br /> (Area Code - Telephone Number)., <br /> Sketch (Detailed plans 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 /> PM <br /> NOTIF: <br /> The undersigned hereby applies for permission to.excavate, c ns, ct and../or <br /> othe . Right-encroach on -County.-HighwayRi ht-of-WaY-on-the side-of <br /> s <br /> . <br /> approximatel L0 feet/ttzftct� <br /> Of , by = errorming the <br /> czrk_LdeSgz ipt on of.work <br /> j two <br /> zlkz <br /> 12 <br /> Work will commence on or about for approximately <br /> 0 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 /> - /Ic <br /> S ture of Applicant Title Daae <br /> MASTER.rs\rassceni (s/oa) RETURN PERMITS TO: <br /> CCD <br /> P6&E <br /> P.O. BOX 930 <br /> STOCKTON.CA 95201 <br />