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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 10/29/14 OFFICE USE ONLY <br /> To: San Joaquin County <br /> JOB# 73 00's �L REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE. -(- j S <br /> PG&E VALID _3 -1-(S TO 4-1 -/S' DRIVEWAYS: <br /> (Applicant Name) STREET /-/y 116 kl- <br /> AREA QUAD S <br /> 850 STILLWATER RD. TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> W. SACRAMENTO, CA, 95605 <br /> (City,State,Zip Code) <br /> 916-760-2934 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> T ¢q, <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_CORRAL HOLLOW RD. approximately_5242' feet/mile <br /> of , ,by performing the following work(description of work): <br /> REPLACING 5242' OF OH CONDUCTOR& REPLACING 15 POLES <br /> Work will commence on or about 03/02/15 for approximately 15 TO 20 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 /> MIKE CONATSER 10/29/14 <br /> Signature of Applicant-Title Date <br /> M:10EWRALSERVICEMCLERICAL'PU"V.WKWASTER.MENCROACNMENTPERMIr APPLICATION.DOC (09113) <br />