Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date —7 Z 1,0' OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE ~= P T <br /> Pacific Gas and Electric Co. VALID t 14 v O � t . l f DRIVEWAYS: <br /> STREET - _{ 7-;- . <br /> P.O. BOX 930 AREA T "lcr; r QUAD <br /> Stockton, CA 95201 TYPE -f'E1 L <br /> FORMS <br /> NOTES <br /> �Z,0q ) 194 2 t6Z-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 ` current M.U.T.C.D. <br /> California supplement. <br /> NOTIF: <br /> The undersir fined hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the� --�-h side of approximately 4 feet/mile 61v <br /> of 01 t G. by performing the followin work(description of work): <br /> a o 9-. <br /> Work will commence on or about gni Zl i o for approximately C 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 /> o 0G�1-t1v f aJ ( -7w/Z9> <br /> Signature of Applicant-Title Date <br /> L.WKWASTEP PSIENCROACHMFNT PERMIT APPLICATIONAOC (07/0 <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br />