Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 4/10/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 REF# <br /> Department of Public Works APN CR# <br /> / EXP.DATE 9-/�- <br /> MARCELINO SAMAGUEY (� <br /> l� 1, VALID y -1- /S TO IS DRIVEWAYS: <br /> (Applicant Name) STREET z- /Q * <br /> 850 STILL WATER'. AREA 5:L&•k-foll QUAD s'S <br /> TYPE � <br /> (Mailing Address) FORMS <br /> WEST SACRAMENTO,CA 95605 NOTES <br /> (City,State, Zip Code) <br /> 925-327-0999 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> PG&E POLE REPLACEMENT, GROUND DISTURBANCE(DIGGING)2-3 FT WIDE AND 6 FT DEEP. ATTACHED PLEASE FIND <br /> ADDITIONAL ASPECTS, CONSTRUCTION DRAWING AND IMAGES OF POLE. <br /> PM: 31123881 <br /> NOTIFICATION:109904140 <br /> COORD I NATES:(37.930498,-121.237559) <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the ROAD side of OUTSIDE 2940 LOOMIS RD PROPERTY approximately 3X6 feet/mile <br /> of 1 , by performing the following work(description of work): <br /> REPLACE DETERIORATED PT SOLELY OWNED POLE AND MAKE IT A JOINT POLE/PM 31123881 <br /> EXISTING POLE LOCATED OUTSIDE 2940 LOOMIS RD STOCKTON CA 95205 <br /> Work will commence on or about 9/1/2015 for approximately 4 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 /> wa-celim JawaLgue y Field Engineer I 4/9/2015 <br /> Signature of Applicant-!Title Date <br /> M:ICENTRALSERVICESCLERICAUPUBSV.WKIMASTER.PS)ENCROACHMENTPERMrr APPLICATION.DOC (09113) <br />