Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: sI 2 <br /> Date ! 0 //;Z1 j ! OFFICE USE ONLY <br /> -To: -San Joaquin County - JOB#- f S - -REF# <br /> Department'of Public Works APN CR# <br /> EXP.DATE f3 <br /> VALID TO i DRIVEWAYS: <br /> Pac i f is Gas & Electric STREET tl�PU <br /> AREA lel QUAD XlE <br /> P.O. BOX 930 TYPE /' <br /> STOCKTON, CA 95201 FORMS <br /> 209-942-1627 NOTES <br /> 1 LC1 — <br /> rc a/ i � t <br /> orl�- rea <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 /> California supplement <br /> PM <br /> Notif. 10 71 q'd q D 6 <br /> The undersigned hereby applies for permission to excavat co ,struct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of 64L.4i'l2re-�� approximately C� feet/mile � <br /> of ao Ac-n A-e ,by performing the following work(description of work): <br /> ©' L <br /> r <br /> e-_1 ea-ze Ad a !6�2 gca& ta -14--ALe-u Ace C <br /> Work will commence on or about JD_1�/r L—:Armen.,, or approximately I 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 /> owl <br /> Signature of Applicant-Title Date <br /> E.IPUe 'I.WKEASTER.PSIENCROACHMENTPERMRAPPLICATION.000 (01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />