Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date /�/. �<'l OFFICE USE ONLY <br /> To; San Joaquin County JOB# 136052-(, REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE 3115-111 <br /> Pacific Gas and Electric Co. VALID 12 g TO 3 ii DRIVEWAYS: <br /> STREET <br /> P.O. Box 930 AREAQUAD S� <br /> Stockton, CA 95201 TYPE trmi-� __ <br /> FORMS <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 /> PM $< /G, , current M.U.T.C.D. <br /> Notif.lv,,jr-�S3 L,73 California supplement. <br /> FIETtlR#4 PERMITS TO: <br /> PG&E <br /> JOB PROCES>sNVCi DESK- 11311-1131 <br /> 4W NYret LN" <br /> 8 1 0CXR CA 95204 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highhwway Right-of-Way on <br /> the �s� N side of_ -© ,n' �' I?n approximately_/ V 3 mile .as r' <br /> of by performing the following work(description of work): <br /> %�> ✓?c' �(%,j �� E' 4� i��ir �}' K�'� ?nR'f`� ",✓ .oc: ;nc;' ,�o >�, v �t'LtC �v�� <br /> Work will commence on or about 0 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 /> Signature of Applicant-Title Date <br /> E:IPUB-SV.WKWSTERPS�ENCROACHMENTPERMTAPPLICATION.DOC (01108) <br />