Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> �11ii <br /> Date �JL .- , l OFFICE USE ONLY <br /> To;_- San-Joaquin_County - -:- - —.__:JOB.#—: --- ✓_ 1 '-REF.-# -= _—_—_ __ - - - <br /> Department of Public Works APN CR#. <br /> EXP.DATE <br /> Pacific Gas a d Electric Co. VALID - TO 11- 1 DRIVEWAYS: <br /> STRE��I `� ET AREA / QUAD j <br /> Stockton, CA 9520 TYPE <br /> FORDS <br /> - NOTES <br /> 51 <br /> (Area Code a Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> 1 <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM --:?�103 Cv 1©t current M.U.T.C.D, j <br /> Notif. 1 i040Z-5116 ' California supplement. <br /> Please return permit to: <br /> CCD Desk i <br /> 4040 West Lane <br /> Stockton, CA 95204 <br /> The undersigned hereby applies f r pe mis ionto excavate,con tract and/or otherwise encro ch on . oVnty Highway Right-of-Way on <br /> the side of approxiii�ately feet/ <br /> of QEiApt4 - EFI-1 D ,by performing the following work(description of work): <br /> Work will commence on or about for approximately. days. <br /> 1,the undersi ned,certify.that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> W escribe above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval., <br /> ^ <br /> 7./Zl/o <br /> Signature of Applicant a Title <br /> D)gle <br /> E;1PU0-SV.WKWASTER.PS(ENCROACHMENTPERMITAPPLICA710N.DDC(011081 <br /> Please return permit to: <br /> CCD Desk <br /> 4040 West Lane <br /> Stockton, CA 95204 <br />