Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: 1 <br /> Date - 1�{�I 4- OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE : _( f- <br /> VALID y-(C9- 14 TO /n- - - DRIVEWAYS: <br /> Pacific Gas & Electric STREET Ho LA et <br /> P.O. BOX 93O AREA � QUAD <br /> TYPE <br /> STOCKTON, CA 95201 FORMS .�j�,,l�Z� <br /> 209-942-1627 NOTES <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 &47k <br /> Notif. <br /> The undersigned hereby applies tor permissioQn to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the & U side of bar+ approximately 2V A 41 feet/ -Va-6-* <br /> of }� Ad16, by performing the following work(description of work): <br /> t ykz lwk <br /> MftL <br /> Work will commence on or about 7w )�. for approximately t2 ZG 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 /> Signature of Applicant-Title Date <br /> E:1PU . MMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC(01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />