Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: ' <br /> Date 3 - 7- /2 OFFICE USE ONLY <br /> To: San Joaquin County JOB REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 7 lZ <br /> Pacific Gas and Electric Co. VALID ; u TO 2 DRIVEWAYS: <br /> STREET <br /> P.O. BOX 930 ; AREA Lobi QUAD AW ' <br /> TYPE ed4e Alk" r1w <br /> Stockton, CA 95201 <br /> FORMS <br /> NOTES <br /> I <br /> -- (205 9y2 -1119S <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan 1 <br /> See attached sketch. ; ; Shall be as per <br /> PM 309v g9o5 current M.U.T.C.D. <br /> Notif. , California supplement. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the L_JE S T side of LOL.J Ql approximately_ 119q feetl=_- A/,O2ri1 <br /> Of A1ZMSr1Z,0 JG 2b. , LDd/ ------,by performing the following work(description of work): <br /> E,C G4 LJA TE AIDL c !90612 GAS /Y!AlA-1 -q-A/Z7 <br /> AIDU_SE ZS To. !3E D i1c��sM�IJ <br /> Work will commence on or about 3- 2-6-12 for approximately 9a 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 /> 3- 7 -12- <br /> 0 <br /> - 7 -12O Signature of Applicant-Title Date <br /> MB-SV.WMMASTERPSIENCROACHMENTPERMTTAPPLICATIONDOC (01108) <br />