Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date -7 OFFICE USE ONLY <br /> To: San Joaquin County JOB REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE ' —?j/—1y <br /> VALID — TO (Q- ��•) S DRIVEWAYS: <br /> Pacif is Gas & Electric STREET <br /> P.O. BOX 930 AREA QUAD x <br /> 1 '6 10 <br /> STOCKTON, CA 95201 <br /> FORMS <br /> 209-942-1627 NOTES <br /> Sketch(Detailed plans may be submitted) <br /> Traff is Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> PM I S I 1�141 California supplement <br /> Notif. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right Way on <br /> the side of 5. !-tllq <br /> of �{ �,,� approximately (Z� feeVmile�_ <br /> S' —1 by performing the following work(description of work): <br /> holes Is _0 _>44, d <br /> in�f�d I to has �u ulL� �r t1e <br /> Work will commence on or about -11-2-1V9,11 for approximately 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 /> N&ob)VWUf <br /> Signature of Applicant-Title Date <br /> EVU NIMASTER.PSIENCROACHMENT PERMIT APPLICATIONDOC (01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />