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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 10/06/14 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73 Z REF# <br /> Department of Public Works APN CR# <br /> PG&E EXP.DATE. <br /> VALID1�_- Z - / TO _C- / — /S DRIVEWAYS: <br /> (Applicant Name) STREET f Rf cjl� <br /> 850 Stillwater Rd. AREA QUAD_ <br /> TYPE orp <br /> (Mailing Address) FORMS ����� <br /> W.Sacramento, CA , 95605 NOTES <br /> (City,State,Zip Code) <br /> 916-760-2934 <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 west _side of S HWY 99 approximately feet/mile <br /> of 7 poles N/O 14849 ,by performing the following work(description of work): <br /> Installing 2- 65' poles in Loc 2 & 3 and Transfering Capacitor from Loc 1 to Loc 4 <br /> Work will commence on or about_ 1/16/15 to 4/30/15 for approximately 2 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 /> did - 61S&""d04- 10/6/14 <br /> Signature of Applicant-Title Date <br /> E.TUB-SV.WKVAASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC(OV08) <br />