Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> i <br /> Data 2/4/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB It ���>> Y 2' ''REF# <br /> Department of Public Works APN �— CR It <br /> PG&E EXP.DATE G) IS'2.U/z� <br /> VALID 3 1�7hi4-T0 _ �(--I�'• 205 DRIVEWAYS: <br /> (Applicant Name) STREET U w-e- kV•t_ ' <br /> AREA QUAD <br /> 4040 WEST LN TYPE 11 kc) D - <br /> (Mailing Address) FORMS S;s WIA) <br /> STOCKTON,CA 05204 NOTES I <br /> (City,State,Zip Code) <br /> 209-942-1421 <br /> (Area Code-Telephone Number) I <br /> • I <br /> Sketch(Detalled plans may be submitted) <br /> SEE ATTACHED SKETCH <br /> PM 42137129 <br /> The underslg nod hereby applies for permission to excavate,constnrct.and/or otherwise encroach on County Hlghway Right-of-Way on <br /> tine QIESI side of S OLIVE approximately 5' feeltmile NORTH <br /> of- W RIPON RD RIPON ,by porforming the following work(description of work): <br /> RAISE FRAME AND COVER DUE TO COUNTY'S RESURFACING PROJECT <br /> Work will commence on or about 3/1/2015 for approximately 30 days. <br /> I,th Adarsignecl,certify that I am the der of the respective property,or am qualified to represent the owner and agree to do the <br /> ►yofk described 9bove In acco�ce, ath the rules and regulailons of San Joaquln County and subject to inspecilon and approval. <br /> 2/4/2015 <br /> Signayr plicant-Title Date <br /> EYV359.I:tUAStERiSf}YFS.UiPetil FEh�tTlfflllTfJIPSC p;(e) <br /> i <br /> (i <br /> !1 <br /> I <br />