Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 4/15/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 2 62_-b REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 7-/, -00/r <br /> PG&E VALID5:-:&1-To -!S'2c DRIVEWAYS: <br /> (Applicant Name) STREET QR. CUc(ae— A <br /> AREA �j� _ VJ-L,�QUAD " <br /> 4040 WEST LN TYPE �p <br /> (Mailing Address) FORMS <br /> STOCKTON, CA 95204 NOTES <br /> (City,State,Zip Code) <br /> 408-316-1767 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> "ll-p1dox.K P <br /> SEE ATTACHED SKETCH <br /> PM 31146635 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the east side of N Gertrude St approximately 594' feet/mile north <br /> of Washington St . Stockton . by performing the following work(description of work): <br /> Excavate(1)4'x4'bellhole to replace gas service to 4 N Gertrude St, Stockton <br /> Work will commence on or about 5/15/2015 for approximately 45 days. <br /> I,the undersigned,certi at I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described e. ccordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> 4/15/2015 <br /> Signa A t-Title Date <br /> E.'WU6SV.WKVAASTER.PSIENCROACHMENT PERMIT APPLICATIONAOC(01108) <br />