Laserfiche WebLink
PLEASE PRINT: <br />Date 11-08-2019 <br />To; San Joaquin County <br />Department of Public Works <br />PGE PM 31422545 <br />(Applicant Name) <br />3136 Boeing Way <br />(Mailing Address) <br />Stockton, CA 95204 <br />APPLICATION FOR ENCROACHMENT PERMIT <br />(City, State, Zip Code) <br />(209) 210-0454 <br />(Area Code - Telephone Number) <br />t8m3@pge.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />)B# <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />7,3pGya. (p REF # <br />CR # <br />3 1 Zv <br />Z $ 1 TO 20 DRIVEWAYS: <br />h6vvi <br />C1 QUAD AIJAI <br />dttv+a� <br />a�►�/ <br />Iry4 - »low <br />Crew to call SJ County Inspector at (209) 953-7421 48 to 72 hours before work starts. <br />When calling, crew shall request "rain clearance" for any work during winter months <br />November through March <br />Pole is approximately 5 feet from the edge of the road. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the `Nest side Of North Ham Lane approximately s53 feet/mile soUtn <br />of Armstrong Road by performing the following work (description of work): <br />Pole Replacement <br />Work will commence on or after <br />12/08/2019 <br />for approximately <br />2 months <br />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 />T. W MaMi�rez <br />Signature of Applicant -Title <br />Y:IFORMS 8 TEMPLATES�ENCROACHMENT PERMIT APPLICATION.doc (OB/OB) <br />11-08-2019 <br />Date <br />