Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 1-12 -13 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 734!�52, REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 313 <br /> VALID 2 j3 T f,� 3 DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET ,t),q , <br /> P.O. Box 930 AREA QUAD 2 <br /> TYPE LL }4C)1� <br /> Stockton, CA 95201 FORMS 55 j,,/1,✓ -z <br /> NOTES <br /> (19-q 9 412- /y49 <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 3D q 7D 4134 current M.U.T.C.D. <br /> Notif. /D/l/3 y1California supplement. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the S Du>/-1 side of i�l 4 A% A LAC approximately 39 1 feedrxbe E4.9 T <br /> of e4/ZL�JyliL ALIZ. , SrZ2elc 'D,c./ ,by performing the following work(description of work): <br /> 550.1 L)14,&1,4 /-i L)E. - m5cv <br /> /-ALL /LJD2/C TD /3E L)DIV Zit/ Z)IPT' 19d2e,4. <br /> Work will commence on or about Z- y-/3 for approximately 19n 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 /> GAS A.L. E. 1- 12-12 <br /> Signature of Applicant-Title Date <br /> E:IPU&SV.WKIMASTER.PSIENCROACHMENTPERMIT APPLICATION.DOC (01/06) <br />