Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE OFFICE USE ONLY <br /> To: San Joaquin County JOB# 5- Co REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE $ o <br /> VALID G a TO /s o9 DRIVEWAYS: <br /> P.G. &E. CO. STREET ot/ 5i <br /> AREA QUAD <br /> 4040 WEST LANE TYPE -8541Xoc..0 <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 :36-7I Z9(oO current M.U.T.C.D. <br /> Notif. California supplement. <br /> 03.7V63-7 <br /> The undersicined hereby applies for Dermission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the s?' sid of— �&A/ T approximately <br /> of 'r17416 '4 S A14 by performing the following work escription of work): <br /> '�✓ ✓� o f t/ XJ t/C, d <br /> ✓t U U <br /> Work will commence on or about z z 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 /> 5/Signature�ofAppplicant-Title Date <br /> F-APUB W.WIOMASTER.PSENCROACHMENT PERMIT APP!ICATION.000 (01108) <br />