Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date -7/Z S (Z <br /> OFFICE USE ONLY <br /> To: San Joaquin County FJOB REF# <br /> Department of Public Works APN <br /> CR# <br /> EXP.DATE l I2- <br /> Pacific Gas and Electric Co. VALID TO DRIVEWAYS: <br /> P.O. Box 930 STREET <br /> AREA /Yef��l7rc.,q QUAD <br /> Stockton, CA 95201 TYPE o <br /> FORMS <br /> NOTES ' <br /> (Area Code-Telephone Number) <br /> r <br /> 7Seeattached <br /> ed plans may be submitted) <br /> Traffic Control Plan <br /> sketch. Shall be as per <br /> PM CJ( X3111-7 current M.U.T.C.D. <br /> Notif. to 5y0 S,(V 0 California supplement. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on Cpunty High ay Right-of-Way on <br /> the �-V side of 5. H 10V q R E-vvn�+sy p (2a( approximatelyZ SS b y <br /> of F'✓. cb. cwt�,,tn 2p( h{-4e fe mile s <br /> S k S by performing the following work(description of work): <br /> ash J` o H�.a � D.4 �ve�t •P /2� <br /> ttJ a 'k �� p / Dl1P '7 Z 7 / <br /> Work will commence on or about for approximately '3� <br /> 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 z���Z <br /> Date <br /> E:IPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />