Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> s , <br /> Date OFFICE USE ONLY <br /> i t <br /> To: San Joaquin County JOB# 7 ,05,a_jam REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 111 <br /> Pacific Gas and Electric Co. VALID to 'P s€ DRIVEWAYS: <br /> STREET <br /> P.O. BOX 930 AREA s iz6&r-H cAmpQUAD <br /> Stockton, CA 95201 TYPE '1�,E 4-PL-F- *Zn9-g- <br /> FORMS actuag2-Z� <br /> NOTES <br /> '942- 162-7 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> SEE ATTACHED SKETCH Shall be as per <br /> PM S'-�.' C.'5', � current M.U.T.C.D. <br /> NOTIF: California supplement. <br /> The pndersig ed hereby applies for ermission to exc vate, co struct and/or otherwise encroach on County Highway Right-of-Way on <br /> the A side-of �JoGl/ approximately � �� feet! �Or+-h <br /> of by performing the following work(description of work): <br /> lho re � 5 v i <br /> Work will commence on or about ( j G for approximately 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 /> U ( `7 tg f;i l C <br /> Signature of Applicant-Title Date <br /> L"MMMASTER-PSIENCROACHMEW PERMR APPLICATION.DOC (01/08) <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br />