Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date -7/1-7109 OFFICE USE ONLY <br /> To: San Joaquin County JOB# �_ REF 7 <br /> Department of Public Works APN CR# <br /> EXP. DATE 9 <br /> VALID 09 T IS- 09 DRIVEWAYS: <br /> P.G. &E. CO. STREET <br /> 4040 WEST LANE AREA TYPE �Ad=nw/ QUAD cu5 <br /> _ * <br /> STOCKTON, CA 95204 FORMS sem, <br /> NOTES <br /> tOcl - -73(49- &461 — <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 30-711&6 4 current M.U.T.C.D. j <br /> Notif. 10-'S e)&-5 3 85 California supplement. <br /> I <br /> i <br /> i <br /> I <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the EAS--r sideof . r�i2�-r2u pF 5 t' approximately ?��l (� feedr !�0 f2Tk-} <br /> of s , by performing the following work(description of work): <br /> Ln <br /> L) <br /> Work will commence on or about 0 for approximately y <br /> da s. <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 /> 1\L0 V-i Seri Vicj <br /> Signature of Applicant-Title Date <br /> LIPUB-SV.WKWASTEP.PSIENCROACHMENTPERl.IITAPPLICnON.000 (01/09) <br />