Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date //-.20 -/y OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73 QRZ REF#- <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and electric Co. VALID _�_-3- l ¢ TO - - DRIVEWAYS: <br /> STREET _� ,MyV1 Optf <br /> P.O. Box 930 AREA Ln( QUAD <br /> Stockton, CA 95201 TYPE / 9 <br /> FORMS _ <br /> NOTES <br /> L209) 9y;2 -/y98 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 3////0703 current M.U.T.C.D. j <br /> Notif. /p-7.7,0;zI2 California supplement. <br /> I <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the it/y/Lr/1! side of /Www4koma ST approximately 91 feet/4@ WZSi <br /> S <br /> of t 1—A" T LDe ,orDXb , by performing the following work(description of work): <br /> 115'40A A01"I"O.cy/-3 S'T <br /> AffX G.*Q L1 4rG WOL.E O[JF�lZ Ll4S /9Ai.J AAI& Cur OFF SE2UlCE. rPLL <br /> Work will commence on or about 12—/T—/y _for approximately 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 /> LAS nE. //-20-/1/ <br /> — .//f —Signature of Applicant-Title Date <br /> EIPUB-SV.WKWASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />