Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 12/29/2014 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE — <br /> PG&E VALID 12[-IS TO DRIVEWAYS: <br /> (Applicant Name) STREET Do",zi <br /> 4040 WEST LN AREA Jf h QUAD �j/ Ii <br /> TYPE 1? <br /> (Mailing Address) FORMS S S1141 t4l <br /> STOCKTON, CA 95204 NOTES <br /> (City,State,Zip Code) <br /> 209-942-1421 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> SEE ATTACHED SKETCH <br /> PM 42299735 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the SOUTH side of Doug Mitchell Dr approximately 20' feet/mile west <br /> of Davis Rd , Stockton by performing the following work(description of work): <br /> Excavate(1)6'x6' bellhole to perform gas main maintenance. <br /> PM 42299735 <br /> Work will commence on or about 2/1/2015 for approximately 60 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 /> 12/29/2014 <br /> Signa ure of Applicant-Title Date <br /> E PUB-SV WNWASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br />