Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 40 - v OFFICE USE ONLY <br /> To: San Joaquin County JOB# ° 3u �-4 REF <br /> Department of Public Works APNCR <br /> EXP. DATE D= ,,' o _ <br /> Pacific Gas and Electric Co. VALID to its TO i? i (, _ DRIVEWAYS: <br /> STREET <br /> P.O. Box 930 AREA QUAD F <br /> Stockton, CA 95201 TYPE TZC N-)C <br /> FORMS Ly�.a f -Z! <br /> NOTES <br /> 205- <br /> (Area <br /> U51 --(Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Pian <br /> See attached sketch. Shall be as per <br /> PM W3 67052 L current M.U.T.C.D. <br /> Notif. /0 y6 17,051 g California supplement. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the .9DU771 side of R4) . Epproximately /D 9!n feeYR4 4e k:A-97" <br /> of f314e� '14 I e5 S7'DZX7DA1 _, by performing the following work(description of work): <br /> AJC C.4Lh17'/DA_lL�/iS /YIDt�C 1 dtI T� > f�/�lJ�lI�YII ,t1T TD <br /> Work will commence on or about. -/5-e'D for approximately ya days. <br /> I,the undersigned, certify that I am the owner of the respective property, or am qualified to represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San_Joaquin County and subject to inspection and approval. <br /> 0"-L, ff <br /> Signature of Applicant-Title E 37-1MnTD12 Date <br /> E'\PUBSI!`NKNAASiER.PSiENCROA-iltJEt,7P;R=AiTAPPLICATIG;:.000 (011108) <br />