Laserfiche WebLink
I <br /> APPLICATION FOR ENCROACHMENT PERMIT ' <br /> PLEASE PRINT: <br /> Date 41 zq I r�:? OFFICE USE ONLY <br /> To: San Joaquin County JOB# � Q(�y�-(� REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID i 0 �_ DRIVEWAYS: <br /> Pac i f is Gas & Electric STREET <br /> AREA oG 'o0 QUAD RA <br /> P.O. BOX 930 TYPE bELL ate. <br /> STOCKT4N, CA 95201 FORMS S� 03 <br /> 209=942-1b27 NOTES o�.iG <br /> Sketch(Detailed plans may be submitted) <br /> Traff is Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement <br /> Notif. 106abIgDr7r2 <br /> The undersi ned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the L. side of E approximately t r feet/ e- IF <br /> of 1 rc,>e:::-, r5 ,by performing the following work(description of work): <br /> Work will commence on or about for approximately 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 /> Qaq <br /> Signature of Applicant-Title Date <br /> E:IPU . MMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />