Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 08/05/15 <br />To:SanJoaquin County <br />Departmentof Public Works <br />PG&E <br />(Applicant Name) <br />4040 WEST LN <br />(Mailing Address) <br />STOCKTON,CA 95204 <br />(City,State,Zip Code) <br />209-942-1599 <br />(Area Code.Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />PM#31173650 <br />NOTIF:110451170 <br />OFFICE USE ONLY <br />JOB#/50(2)2 REF# <br />APN CR#____0__ <br />EXP.DATE 7-/-1 ~_----VALID 'f-I-fb 'TO 7-1-/"DRIVEWAYS: <br />STREET ~t\il14dl1l1ClJ1 It t/.--• <br />AREA 'Jt~5101~QUAD -41 W • <br />TYPE • <br />FORMS 55 WlV IlL"Try",lJ <br />NOTES <br />'- <br />SEE ATTACHED SKETCH <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br />the SOUTH side of WAlJDMAN AVE approximately 305'feeUmile_E __ <br />of AGATE AVE ,STOCKTON,by perfomningthe following work (description of work): <br />EXCAVATION OF (1)BELL HOLE IN ASPHALT. <br />Work will commence on or about 08/10/15 for approximately __9_0~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 />~It-Mwgu-S"r (4C <br />Signature of Appllcant-TItle <br />08/05/15 <br />Date