Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 5l Z81 i�j OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID —g—( TO $ DRIVEWAYS: <br /> Pacific Gas & Electric STREET S <br /> P.O. BOX 930 AREA —LO di QUAD IfIV <br /> STOCKTON, CA 95201 <br /> PE <br /> FORMS ky4lZ� <br /> 209-942-1627 NOTES T <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 l �57��?J California supplement <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 D side of����1- (,(1• approximately I Zo ' feet/ �c_c� <br /> of X00 L.�A4- _, by performing the following work(description of work): <br /> V IG Q,5 Cv <br /> Work will commence on or about _for approximately �p 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]PLI KIMASTERPSIENCROACHMENT PERMIT APPLICATION DOC (01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />