Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 9/5/2014 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73 0 S Z REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE H - ( - (¢ <br /> PG&E VALID Z-1 - Jq TO DRIVEWAYS: <br /> (Applicant Name) STREET 7n,AoIfUS <br /> AREA STS r IC�t_)M QUAD / I/ <br /> 4040 WEST LN TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> STOCKTON, CA 95204 <br /> (City,State,Zip Code) <br /> 209-942-1421 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> SEE ATTACHED PLANS <br /> PM 31068193 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the NORTH side of DOUGLAS RD approximately 83' feet/mile EAST <br /> of N WILLIAMSBURG PL STOCKTON by performing the following work(description of work): <br /> EXCAVATE (1) 4'x4' BELLHOLE, BEHIND BACK OF SIDEWALK, TO REPLACE GAS SERVICE TO <br /> 2055 DOUGLAS RD, STOCKTON <br /> Work will commence on or about 10/1/2014 for approximately 30 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 /> 2z <br /> VK1_= S1 <br /> Signature of Applicant-Title Yate <br /> E.PUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br />