Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Datey?l I OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 ( SZ REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE 7-1 -1,5' <br /> VALID4-7-15. TO 7-1 -1 DRIVEWAYS: <br /> Pacific Gas & Electric STREET 146S0Y' <br /> P.O. BOX 930 ABA y1 QUAD <br /> TYPE <br /> STOCKTON, CA 95201 FORMS f5 irl ,CZ <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 /> PM <br /> California supplement <br /> 3t 12.�g2� <br /> Notif. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the t—A side of 6 �r approximately & feet adi�c� <br /> of , by performing the followin work(description of work): <br /> t Zt IS. <br /> Work will commence on or about \]?,I 115 for approximately •q 0 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:IP MMASTER.PSIENCROACHMENT PERMIT APPLICATION DOC (01/08) - <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />