Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date April 06, 2012 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 3p` REF# <br /> Department of Public Works APN CR# <br /> Ed Arroyo, (PG&E Employee) EXP.DATE Y <br /> VALID f TO Z DRIVEWAYS: <br /> (Applicant Name) STREET eV, <br /> AREA QUAD W <br /> 850 Stillwater Rd TYPE <br /> (Mailing Address) FORMS w <br /> NOTES <br /> West Sacramento, CA 95605 Sac RMC Of <br /> (City,State,Zip Code) EGr <br /> 916-760-1945 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> This job estimate is for replacing poles due to a new Round About <br /> being installed. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of approximately feet/mile <br /> Of ,by performing the following work(description of work): <br /> Please refer to construction drawings for work locations. <br /> PG&E will be relocating some ting overhead conductors and replaring 7 poles. equipment <br /> and replaceng/removina/installina down_gllvs is reciired_ <br /> Work will commence on or about May 15, 2U12 for approximately 90 days. <br /> I,the undersigned,cer dy 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 /> � _�Electric Estimator � � <br /> Signatur f Applicant-Title Date <br /> E V1165Y'MI9MSTStf'SE)ICPOM711kM Pk7d1 N'M1U1104000 PLp) <br /> PS-12-oIoS-�- <br />