Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date r OFFICE USE ONLY <br /> To: San Joaquin County JOB# - , REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE d D <br /> VALID TO r7 15' (>2 DRIVEWAYS: <br /> P.G. &E CO STREET &tjAi�o <br /> AREA '�hi QUAD et <br /> 4040WEST LANE TYPE -jL5F-LL HOL& <br /> STOCKTON, CA 95204 FORMS <br /> NOTES <br /> Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM %U '' '=' current M.U.T.C.D. <br /> Notif. y.� -- t ' California supplement. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of z:2-,,�> approximately i 7-_5 -' 'f e-e-9 mile <br /> ofby performing the following work description of work): <br /> 7;;7 ,v�_.n!`'�.. fl�: i/ d.�'• �; �. �J- / /J,s .l�Xlt:,`,'/.�• /J'� :-�/ti'�f��'`�f� �U /Ct�C. �' `, f!"�: �5 "�. <br /> '' �/'j'"7�✓ �'�/ 1 .>£.,C'-• .�-y;J _err/-�;., ,-/� .,.yJ .r �-' r�y1-�f7� ._f,-y: / � �,>ulf-t` �j/-yi <br /> TT <br /> ' 1 <br /> 'Work will commence on or about "' v 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 /> Signature of Applicant-Title Date <br /> E9PUB.SV.WNIMf STERPSIENCROACNMENPERMFr APPLICATION.DOC (01109) <br />