Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 10-5-12 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7Q-3 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 1 1 <br /> AT&T CA C/O: ROBERT SCHEPPMANN VALID TO 1111112 DRIVEWAYS: <br /> (Applicant Name) STREET Rfl• <br /> AREA QUAD N(AD <br /> 2300 E Eight Mile Rd #100 TYPE 7W4W---H <br /> (Mailing Address) FORMS ss./ fM4 l2 Z`i <br /> NOTES � r <br /> Stockton, CA 95210 <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 /> AT&T PROJECT 8643345, Drawing 1 of 2 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the North side of W. Barber Rd approximately 75 feet feet/mile East & West <br /> of 5 Freeway ,by performing the following work(description of work): <br /> Trench & place 394' feet of 1-4" conduit in dirt from pole P10430 <br /> to pole P10390 <br /> Work will commence on or about 10-22-12 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 described ab in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> ig - 4. goloet matime'r 111-242-10440 16/54 <br /> ure of plicant-TitTe Date <br /> E:IPUMV. T .P ENCROACNMENTPERMITAPPLICATION.DOC (07108) <br />