Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 10111112- OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID 16 q z TO 1 DRIVEWAYS: <br /> Pacific Gas & Electric STREET 6,06A-g ,e D, <br /> P.O. BOX 93O AREA W-OXVTa QUAD /VW <br /> TYPE -8E1,1' HOLE <br /> STOCKTON, CA 95201 FORMS 55 ww, ,�Z19 <br /> 209-942-1627 NOTES �T <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> PM � n t258 California supplement <br /> Notif. !owl <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side ofL>!.1ll-r!�(�*i��lE F)p approximately leo I ` feet/ 5�" <br /> of by performing the following work(description of work): <br /> o p <br /> Work will commence on or about 10011, 7 for approximately days. <br /> r to <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 Date <br /> E:WU . MMASTER.PSIENCROACHMENT PERMIT APPLICATION.000 (01/08) - <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />