Laserfiche WebLink
APPUCA TION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT:9 ..,8'0°',,~<!"',HIl.R '-'("'1''Ji:.u In n,~"..'-. <br />Date 2/25/2016 <br />To:San Joaquin County <br />Departmentof PublicWorks <br />PG&E <br />(Applicant Name) <br />4040 WESTLN <br />(Mailing Address) <br />STOCKTON,CA 95204 <br />(City,State,Zip Code) <br />408-316-1767 <br />(Area Code -Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />.-, <br />OFFICE USE ONLY c)~r .,\"I '.'...-, <br />JOB#13005~REF# <br />APN CR# <br />EXP,DATE ~IIh,- <br />VALID 4'ilJIP to c.,I(III"DRIVEWAYS: <br />STREET &11<:tJJti'1 • <br />AREA ~,,<./c'.()QUAD f,V • <br />TYPE ;gel/#"Ie • <br />'FORMS ~~,1:-29NOTES <br />SEE ATTACHED SKETCH <br />The undersignedhereby appliesfor permissionto excavate,construct and/or otherwiseencroach on County HighwayRight-of-Wayon <br />the South side of W Polk Way ,approximateiy 372'feet/mile East <br />of N Alexandria PI ,Stockton,by performingthe followingwork (descriptionof work): <br />Digging up 4'x4'of grass/dirt for a service replacement to 2256 W Polk Way.Proposed bell hole in grass. <br />PM 31220147 <br />Workwill commenceon or about__4~/~01/~2~0~1~6 for approximately 60 days. <br />o Applicant -Title <br />I,the undersigned,certifythat I a wner he respectiveproperty,or am qualifiedto representthe owner and agreeto dothe <br />workdescribed abov2Q ance'e rules and regulationsof SanJoaquinCountyand subjectto inspectionand approval. <br />~-Yd,-I/& <br />I Date <br />E:\PUB-SV.WKIMASTERPSIENCROACHI,£NT PERMT APPLICATlON.DOC (OilO8)