Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date _ /�� �`,�/rV <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# i30057_ REF# <br /> Department of Public.Works APN CR# <br /> EXP. DATE <br /> Pacific Gas and Electric Co. VALIDZ A 0y ,� DRIVEWAYS: <br /> P.O. Box 930 STREET G <br /> AREA QUAD �5 <br /> Stockton, CA 95201 TYPE <br /> FORMS Zc; <br /> NOTES <br /> r <br /> (Area Code-Telephone Number) <br /> 7Se7eattached <br /> ed plans may be submitted) <br /> Traffic Control Plan <br /> sketch. Shall be as per <br /> PM ,..>-4"4current M.U.T.C.D. <br /> Notif. California supplement. <br /> RETURN PERMITS TO: <br /> PG&E <br /> JOB DESK- BL.D I <br /> MM~L WW <br /> STOCK10I+t. CA 95204 <br /> The undersigned hereby applies for permon to excavate,construct and/or otherwise encroach on County Highwa Right-of-Way on <br /> the_,�y� _ <br /> of --a side of�� approximately e ile <br /> by perforrnin the fol.0rig work( escription of work): <br /> lop <br /> � a <br /> Work will commence on or about_ Zfor 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 <br /> Date <br /> E:PUB-SV.WKWASTERPSIENCROACHMENT PERMIT APPUCATIONAOC (07108) <br />