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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 04/17/15 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 730(95_Z REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE S <br /> PACIFIC GAS & ELECTRIC VALID —1- TO 5- -15; -L5 DRIVEWAYS: <br /> (Applicant Name) STREET / <br /> AREA ±Z k-�()\QUAD <br /> 850 STILLWATER DR TYPE ,� s Uz W <br /> (Mailing Address) FORMS p <br /> NOTES <br /> WEST SACRAMENTO, CA 95605 <br /> (City,State,Zip Code) <br /> 925-327-0990 <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 Highwa Right-of-Way on <br /> the EAST side of DELAWARE AVE approximately 105 ee ile SOUTH <br /> of CHRISTINA AVE , STOCKTON —,by performing the following work(description of work): <br /> REPLACING EXISTING 45' POLE WITH NEW 50' POLE. REPLACING EXISTING DOWN GUYS AND <br /> ANCHORS WITH NEW DOWN GUYS AND ANCHORS. <br /> Work will commence on or about 05/01/15 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 /> CONSULTING FIELD ENGINEER 04/17/15 <br /> Signature of Applicant-Title Date <br /> M,CENTRALSERVICES4CLERICALIPUB-SV.WKIMASTER.PS%ENCROACHMENT PERMIT APPLICATION DOC (09/77) <br />