Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 711 e�>41 t OFFICE USE ONLY <br /> To: San Joaquin County JOB# P 3a,} -2RE# <br /> Department of Public Works APN CR# <br /> EXP.DATE _ I <br /> VALID ZL-Zc>L_l TO l - DRIVEWAYS: <br /> Pacif is Gas & Electric STREET <br /> P.O. BOX 930 AREA \^C" QUAD 5' <br /> TYPE <br /> STOCKTON, CA 95201 FORMS _ zk„uj f ? _ <br /> 209-942-1627 NOTES <br /> Sketch(Detailed plans may be submitted) <br /> Traff is Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement <br /> PMS <br /> Notif. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-qf-Way on <br /> the side of �, - 1-!'M-16,_Q f approximately lG�,40 feet/wie <br /> of , by performing the following work(description of work): <br /> Work will commence on or about for approximately LE42-- 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 /> 11 <br /> Signature of Applicant-Title t Date <br /> E: MMASSUWNCROAaNMEWPERWAPPU=ON.DOC(Ma) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />