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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 02-25-13 OFFICE USE ONLY <br /> To: San Joaquin County JOB# goo 3 REF# <br /> Department of Public Works APN A CR# <br /> AT&T CA C/O: Don Seelye EXP.DATEVALID I DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA p QUAD <br /> 2300 E. Eight Mile Rd TYPE <br /> (Mailing Address) FORMS 2 1 _ <br /> Stockton, CA 95210 NOTES <br /> (City,State,Zip Code) <br /> 209-474-4364 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> REFER TO ATTACHED PLANS <br /> � 157C�o <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 03-11-13 Y......... .. .: <br /> . for approximately <br /> I,the undersigned,certify that I 9m the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accor nce with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> 2125113 <br /> Sign a of icant-Title obate <br /> E PUMV.WKWASTER EWMi7APPUCATiON.DOC(010) <br />