Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date zo OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7S A) REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE /S <br /> Pacific Gas and Electric Co. VALID TO ��_ DRIVEWAYS: <br /> P.O. Box 930 STREET Al" ,yp. <br /> Stockton, CA 95201 TYPE QAD� -- <br /> FORMS -S5 mow, Ae.Z'7 <br /> NOTES <br /> .21)9 - <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 306775(13 current M.U.T.C.D. <br /> Notif. 103f?-7L16 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 S041771 side of LJ. 7'uR.niER �STAKTIAIL approximately I0.5 feet/ [vES� <br /> of L.�, �] ei4,V/9 L by performing the following work(description of work): <br /> �iV.S'Tf'JL� AIELJ ��9 Ffs1ClLJ T! / <br /> &A IYo r- _ X7—w7-1,0A-1 <br /> ®iS7'2���- RLQ T i2 / B ,tl <br /> FYC/L/7-Y. Oc�l�J <br /> Work will commence on or about A100 O 9 for approximately gp <br /> 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 /> fs Signature of Applicant•Title <br /> G S7-1 M,17-0/2 Date <br /> E:IPUS-SV.WKIMASfER.PS1ENCROACHMENTPERMrTAPPUCATION.DOC (01M) <br />