Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE Z t T 6 <br /> Pacific Gas and Electric Co. VALID I1i(la TO DRIVEWAYS: <br /> STREET C«,^ u� $1� <br /> P.O. BOX 930 AREA 5707 td'4t) QUAD <br /> Stockton, CA 95201 TYPEa 1!10 Ne_ <br /> FORMS s'.5U�— <br /> NOTES <br /> 209 ) qlz- /h/9v <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 30491033,5 current M.U.T.C.D. <br /> Notif. /p ygG yy0o California supplement. <br /> SEE �rr�cH�� msxErc� <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the .5 11?-Z;;I uT2BI-LIZ of Co .VY C -af cJD approximately l.SO feet4R4a l4sT <br /> Of-1J�2 L�.Vi� [�/ STQe=KTati/ by performing the following work(description of work): <br /> EXe1-?[JA TE. HELL_ //ULE" ou�E' Gras MA iAl /qAly 13o�PF .t! <br /> Work will commence on or about !-/VDt/-to for approximately ..30 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 /> 'SR X14,5 !"D-/6-!b <br /> Signature of Applicant-Title E-S1`11 1?7-Of2 Date <br /> ' EIPUB•SV.WKIM0.SfERP51ENCR0ACHMEM PERMfT APPLICATION.DOC (OtAB) <br />