Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date t 11c �I 1 OFFICE USE ONLY <br /> To: San Joaquin County JOB# ?,J9V,4p REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 5-110/;- <br /> VALID o C/ 0. S DRIVEWAYS: <br /> Pacific Gas & Electric STREET Eye SPD. <br /> P.O. BOX 930 AREA QUAD <br /> TYPE .GE <br /> STOCKTON, CA 95201 FORMS ss <br /> 209-942-1627NOTES <br /> ,I <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> shall be as per j <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement j <br /> Notif. 1054Z-7 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of 1 I i e.r 14Zapproximately �4 <br /> of (l Gym by performing the following work(description 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 and approval. <br /> �+� � �� ��h�-ice ���-1 ► � . <br /> Signature of Applicant-Title Date <br /> E:1PU . WASTERPSIENCROACNMENTPERWAPPLICA710N.DOC 01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />