Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 3 /3' (S OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 6 -15-1 S <br /> VALID ¢-Lz-(S TO CO L�lS_ DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET _ WA f� <br /> P.O. BOX 930 AREA Oockqo�), QUAD <br /> Stockton, CA 95201 TYPEFORMS w(4/ 22c� <br /> NOTES <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per i <br /> PM ,31 I tl qq%a current M.U.T.C.D. j <br /> Notif. I California supplement. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County High Right-of-Way on <br /> the F A 5 side of W-i-P L r-1 0C- approximately I L., D fee mile So U. tx <br /> of � C U�+• ,by performing the following work(description of work): <br /> x CAO A1* IF 40 ' cul l o,cF <br /> 13 J( P01,P %i i 0 ASH4 4 �Z .N Di✓� , <br /> Work will commence on or about for approximately t 'b y 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 /> ' S/2- 67,4--5- 2Ss/,'ww10,Lo <br /> Signature of Applicant-Title Date <br /> E:IPNB WWKIMASTER.PSIENCROACHMENT PERMIT APPLICATIONAOC (01108( <br />