Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINf: <br /> Date OFFICE USE ONLY <br /> -_ To:-_-_. San Joaquin_Countv- _ - - - -_- =JOB# <br /> Department of Public Works APN _ _ CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID - t�-1 TO I()-j(-lS DRIVEWAYS: <br /> i � i� STREET <br /> �� ! e5i—• U,,,1 AREA S QUA <br /> Stockton, CA 95204- TYPEFORMS Z <br /> NOTES _ <br /> (Area Code a Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> - 1 <br /> Traffic Control Plan ; <br /> See pttached sketch. ', Shall be as per <br /> PMcurrent M.U.T.C.D, j <br /> NotOr I ICA >2.6I10 California supplement. <br /> Please return permit to: <br /> CCD Desk <br /> 4040 West Lane <br /> Stockton, CA 95204 <br /> .The undersigned hereby applies for ermission to cavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of >_ approximately 272 feet iie t <br /> of AN ,by performing the following work(description of work): <br /> L LE—_- 5 <br /> Work will commence on or about 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 d above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval., <br /> R J <br /> Signature of Applicant:a Title Date <br /> E;1PU6-SV.WIDMASTER.PS(ENCROACHMENTPERWTAPPLICATION.DOC(D1/08) <br /> Please return permit to: <br /> CCD Desk <br /> 4040 West Lane <br /> Stockton, CA 95204 <br />