Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date e OFFICE USE ONLY <br /> To: San Joaquin County JOB t REF <br /> Department of Public Works APN CR r <br /> EXP. DATE <br /> Pacific Gas and Electric Co. VALID I 6 T 6 DRIVEWAYS: <br /> STREET 6,_ er.. <br /> P.O. Box 930 AREA :GOD! QUAD <br /> Stockton, CA 95201 TYPE 1-1119Z,E <br /> FORMS ZOLIW <br /> NOTES <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 /> P ';' � ,`"' ^ ;"°' current M.U.T.C.D. <br /> Notif. -; 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 �/P�f`Tt _side of 1'4At'ee /&. approximately -;711 fe�mile /,yfsT <br /> of A A�-i ex r,�. _ zzw; by performing the following wor escription of work): <br /> �✓/ j?G•�Q_ !✓ �cltaj/f N /QJ✓P' << t�PA�rf ,s7 i /t <br /> �S r�AG i✓� r'e-S• _ �Gt/�'1Q'r1G� �A✓J�t f f sc/ -- <br /> i <br /> r r <br /> 7 r <br /> Work will commence on or about -S d 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 /> Sig ature of Applicant-Title ' Date <br /> L:4PUB-SV.WNVNMSTLR.PS.E`JCRCACt'ML^:TPFRrAITARPLICATO.N.DOC ;01C3) <br />