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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 0-1 -08-15 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 3 d Q�j Z REF# <br /> Department of Public Warks APN _ CR# <br /> PG&E (ED ARROYO) EXP.DATE Cf_(37 <br /> VALID TO 4-(_ -1 S DRIVEWAYS; <br /> (Applicant Name) STREET prig meek 2 <br /> cA� <br /> AREA TYPE TrI a�( dor QUAD /1/ E ` <br /> 850 STILLWATER RD c;�lc �, �� <br /> (Mailing Address) FORMSC <br /> _. <br /> W. SACRAMENTO CA, 95605 NOTES <br /> (City.State,Zip Code) <br /> 916-760-1945 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> THIS JOB ESTIMATE IS TO REPLACE A TRANSFORMER. NO DRILLING OR TRENCHING <br /> WILL BE DONE ON THIS JOB. THE CREWS WILL HAVE TO PARK THEIR TRUCKS ON THE <br /> WEST SIDE OF DRY CREEK RD AND TAKE 1 LANE. <br /> PM 31117623 <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 /> THIS JOB WILL NOT BE ON THE HIGHWAY. <br /> Work will commence on or about`a. I_ for approximately 1 , 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 /> ESTIMATOR <br /> 01-08-15 <br /> Signature of pplicant-Title Date <br /> '/=:NT2%1-5Ek•rcESG,ERtC:.wu3 <br /> $V.VN1".STFR.PA=NCROACN4<_NT PERMR APFUCAIDN.COO mM31 <br />