Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 2L - /2- OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID ; TO 3a"' , : DRIVEWAYS: <br /> STREET <br /> P.O. BOX 930 AREA e: G QUAD ' <br /> Stockton, CA 95201 TYPE wa) L-i&s ' <br /> FORMS <br /> NOTES r <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 4-1I9/S132 current M.U.T.C.D. <br /> Notif. AolkS2/2oS 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 ER.S7- side of "ems S7'1ZLz-c7-. S-rAP-n1,1& approximately ,200 feet/mile A/o27N <br /> of In/S 1-'6:TDE AL-1 . .SK.7-,,nAl by performing the following work(description of work)- <br /> -3/ I/Ii/ A.I. .S'7-)2Z--&-T`- <br /> f x C.gyAi G �/ Nyc ES ©uz"fZ 6,4S 1,,41" 7:L3 <br /> L 641/ 'S. <br /> Work will commence on or about 11-22- 12- for approximately ,r'u 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 Date <br /> E:IPUB-SV.WKIMASTERPSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />