Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> _ <br /> -To: - - San Joaquin_County JOB# �30b �-Co ___ REE#- <br /> Department of Public Works APN CR# <br /> EXP.DATE -j <br /> VALID 5 TO /(S. ( ?- DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET qfgb►� <br /> P.O. Box 930 AREA 5�bcTr c;D QUAD <br /> "$ao� w o <br /> Stockton, Cha 95201 TYPE FORMS S , P--2,3, <br /> NOTES <br /> 2 �� 2- �g2 - <br /> • (Area Code�Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> - 1 <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM —3102.,E `� current M.U.T.C.D. j <br /> Notif. California supplement. <br /> I <br /> The un ersigned hereby applies f r ermission to excava , construct and/or otherwise encroac on County Highway Right-of-Way on <br /> the side of approximately feetiaM <br /> Of ,by perfooj�nin the followin work(description of work): <br /> 16L3 AJC ALV <br /> D eP_ o Ll lc-:F o <br /> Work will commence on or about for approximately days. <br /> f,the under; ned, certify.that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> wor scrib above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval., <br /> �. f�2o1 - <br /> ignature of Appl can <br /> -Title Date <br /> E:1PUB-SV.WKWASTER.PS(ENCROACHMENLPERMITAPPLICATION.DOC (01108) <br /> Please return permit to: <br /> CCD Desk <br /> 4040 West Lane <br /> Stockton, CA 95204 <br />