Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �� 14- <br /> t-- OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7S06-AS2- G REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE. <br /> VALID 1.1-1-201y TO1ILt _ DRIVEWAYS: <br /> Pacif is Gas & Electric STREET 'r`..��.c��r Ra. _ <br /> AREA Lo 6,t QUAD N W <br /> P.O. BOX 930 TYPE _ <br /> STOCKTON, CA 95201 FORMS to_% TveA�&C'1141vs �'y <br /> 209-942-1627 NOTES <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 /> PM 'Jt a5 <br /> California supplement <br /> 220 - <br /> Notif. <br /> The u dersi ned hereby applies for permission to excavate, construct and'or otherwise encroach on County Highway Right-of-Way on <br /> the side of A. �(vrher A- approximately l l m _feet4=k <br /> of t!X?Sal F%9A by performing the ollowing work(description of work): <br /> Work will commence on or about for approximately o 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 /> N& � - - tv 114- <br /> Signature of Applicant-Title Date <br /> E:' . KWASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC(01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />