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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 5/6/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 3�00.2 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE. 11-1-15 <br /> �� "" <br /> HIN-CHLING LI (ALAN)�y Q;�] VALID TO i !-1—��_ DRIVEWAYS: <br /> (Applicant Name) STREET fi--fAch <br /> 7 ,` PU AREA QUAD <br /> (Arft _ <br /> W1' TYPE <br /> (Mailing Address) FORMS F SWAY Z� <br /> NOTES <br /> (City,State,Zip Code) <br /> 925-327-0990 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> PG&E PM#31119070 <br /> NOT:109590383 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the North side of French Camp Rd. approximately 540ft feet/mile NW <br /> of 10000 French Camp Rd., Manteca, CA 95336 by performing the following work(description of work): <br /> Pole Replacement <br /> Work will commence on or about for approximately �1 r�� 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 /> Hin-Chung Li (Alan) <br /> Engineering Estimator- Electric 5/6/2015 <br /> Signature of Applicant-Title Date <br /> M9CENTRALSERVICESICLERICAL\PUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (09113 <br />