Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# R*McIS-24 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE +r,-(—2-,e>l 4 <br /> VALID S-1— 20 L tTO C^I=1Dl U DRIVEWAYS: <br /> Pacific Gas & Electric STREET 6q,,1V CCS. <br /> P.O. BOX 930 AREA � UAD 55TYPE e <br /> STOCKTON, CA 95201 FORMS SSjw <br /> 209-942-1627 NOTES <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> s hal I be as per <br /> See attached sketch. current M.U.T.C.b. <br /> Cal ifornia supplement <br /> PM ,. 4 - r <br /> Notif. lo-1 l ejl,p <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the Sty�;+ side of ® f approximately ?�7— : feet/Aft 66u <br /> Of I l0.11��c tai b performing the following work(description of work): <br /> _ 2Adflofa O&�5 UIQ . <br /> Work will commence on or about �nI A for approximately 90 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 /> Q�o \& aw, U , I)f. �' Z-1 I t <br /> Signature of Applicant-Title Date <br /> E:" . KIMASTERPSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 91.5201-0930 <br />