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C LA(p APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 10/30/14 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 3 DUSZ REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Jordan McKay(Pacific Gas and Electric) VALID l(-(q-14 TO _A-Z—/!;- (f DRIVEWAYS: <br /> (Applicant Name) STREET )fid f <br /> AREA !n d(� QUAD <br /> 2730 Gateway Oaks TYPE T i-Giff Ic <br /> (Mailing Address) FORMS <br /> NOTES <br /> Sacramento,CA,95833 <br /> (City,State,Zip Code) <br /> 916-583-5594(Office),916-296-6684(cell) <br /> (Area Code-Telephone Number) <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 North side of Jahant Rd approximately feet/mile 1 Mile <br /> of by performing the following work(description of work): <br /> Removal of trees on private and private/county property along Jahant Rd.The work area will be from the West corner of 3098 W Jahant Rd <br /> to the intersection of Lower Sacramento Rd.The majority of these trees fall on private property,but some may be within the county right of way. <br /> We have been working with the Private owner and have an agreement in place regarding the removal of these trees. <br /> Work will commence on or about November 10,2014 for approximately 7-10 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 o in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval, <br /> /0 Aob I/ <br /> Signature of Applicant-Tit Date <br /> PM 44- yl� oaL) 4� <br /> MICENTRALSERVICESICLERICALIPUB-SVWKIMASTER.PSIENCROACHMENTPERMRAPPLICATION.DOC (09/13) <br />