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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To: San Joaquin County JOB # REF # <br />Department of Public Works APN CR # <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />(Applicant Name) STREET * <br />AREA QUAD * <br />TYPE * <br />(Mailing Address) FORMS <br />NOTES <br />(City, State, Zip Code) <br />(Area Code - Telephone Number) <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <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 />Work will commence on or after _____________________________________ for approximately ________________________ 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 />Signature of Applicant - Title Date <br />3/24/23 <br />Vasko Electric Inc. <br />4300 Astoria Stree <br />Sacramento, California 95838 <br />(916) 568-7700 <br />PaulS@vasko.com <br /> <br /> <br />East HARLAN ROAD 25' <br />110 E Transportation Ct Property Fence Line <br />Digging for a 26" Wide x 54" Deep Dry Utility Trench and installing (1) 4" Underground Primary PG&E Conduit. <br />5/15/23 3 <br />3/24/23 <br />AREA OF <br />WORK <br />S. Harlan Road <br />ubmitted) <br />00023 <br />00027 <br />AREA OF <br />WORK <br />Project Manager <br />4300 Astoria Street <br />New PG&E Pole <br />15' Fra <br />n <br />c <br />h <br />i <br />s <br />e