Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �� I OFFICE USE ONLY <br /> To: San Joaquin County JOB# �3q� .jREF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 3 el <br /> VALID 9 r 8 rl TO 31 !ol DRIVEWAYS: <br /> Pacific Gas & Electric ; STREET 51cV,g 5t <br /> P.O. BOX 930 AREA 5TQck z*n/ QUAD 55 <br /> TYPE voce ZaceoLArenode- <br /> STOCKTON, CA 95201 FORMS ss��, _Zg <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 /> PM ! Z Z <br /> Notif. ;6,3E4A 4- <br /> The undersi ed hereby applies fopermis ' n to excavate,construct and/or otherwise encroachlon County Highway Right-of-Way.on <br /> th approximately feel'side of '` <br /> Of by performing the following work(des ription of work): <br /> Work will commence on or about 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,Ind approval. <br /> Signature of Applicant-Title Date <br /> EPU SIFNaMa*&NTPSWAPPUCATI0N.D0C(OLDS) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />