Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 09-05-12 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE d 2 <br /> AT&T CA C/O: R. Scheppmann VALID z p Y DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREAD.4iVj QUAD 4/ <br /> 2300 E. Eight Mile Rd TYPE �� I <br /> (Mailing Address) FORMS j✓ <br /> Stockton, CA 95210 NOTES <br /> (City, State,Zip Code) <br /> 209-474-4052 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> REFER TO ATTACHED PLANS <br /> ATT P eject * 97 t 574DO <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 W. Oak St approximately 820 feet feet/mile East <br /> of N. Sacramento Blvd by performing the following work(description of work): <br /> Trench & place 247 feet of direct buried cable from pole 8424 to pole 8410 <br /> Work will commence on or about 09-17-12 for approximately 3 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 describgCR0A11'ERP111TAPPUCAT10N.D0C <br /> rdance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> 09 5 IZ <br /> Sigan -Title 2't2-0't't0 ate <br /> E'IPUB-SM MASTERPS (01/08) <br />