Laserfiche WebLink
PLEASE P APPLICATION FOR ENCROACHMENT PERMIT <br />PRINT: <br />Date ----- --- <br />OFFICE USE ONLY <br />To. San Joaquin County <br />Department of Public Works <br />SOB # 730052 REF # <br />APN _ CR # <br />P—�_____ <br />(Applicant Name) <br />EXP.DATE <br />VALID 7/22/2023 TO 1/22/2024 DRIVEWAYS: <br />STREET Edwards Ave. <br />31369 Way <br />AREA Escalon QUAD SE <br />TYPE Aarial Work <br />(Mailing Address) <br />FORMS SSM/W <br />Stockton Ca, 95206 <br />NOTESns <br />(City, State, Zip Code) <br />(408)316-1767 <br />(Area Code - Telephone Number) <br />STDivPGEPenNts@pge.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />!L::::: <br />�� <br />i✓�"".15 �i N <br />tl� <br />x <br />PL <br />The unders ned hereby applies for prmission excavate, construct andlor otherwise encroach on unty highway rightof- ay on <br />the side of c.���� approximately h� o Q feed Qmile + _ <br />ofwe by performing the following work (description of work): <br />--1 -6 V f✓ <br />f <br />3 SZ <br />!P v <br />Work will commence on or after 1 t? --7-3 <br />for approximatety 180 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 wnlesa <br />tions of San Joaquin County and subject to inspection and approval. <br />%/l Z1Z '3 <br />Sign pl' Tide <br />Date <br />