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APPUCATIONTOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 6/30/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# ��Q�s' Z REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 11-1-15 <br /> MARCELINOSAMAGUEY VALID n-1v u TO DRIVEWAYS: <br /> (Applicant Name) STREET <br /> _ <br /> 850 STILL WATER DR. AREA lenWdlen QUAD <br /> TYPE J�ee <br /> (Mailing Address) FORMS 55 wk-' Q?_9 <br /> WEST SACRAMENTO,CA 95605 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 WILL REPLACE A POLE,THERE WILL 3E GROUND DISTURBANCE(DIGGING)2-3FT WIDE AND T DEEP.ATTACHED PLEASE <br /> FIND ASPECTS,CONSTRUCTION DRAWING-AND IMAGES OF EXISTING POLE. <br /> PM31140359 <br /> N OTI F I CATI O N:109997444 <br /> COORDINATES(37.902622,-121.04483) <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 7307 MOBLEY RD!OCKTON CA 95215 approximately 2000 <br /> PP Y feet/mile Fr <br /> of CROSSING ST GAWNE RD ,by performing the following work(description of work): <br /> REPLACE DETERIORATED POLE/PM 31140359 <br /> POLE LOCATED IN FRONT OF 7307 MOBLEY RD STOCKTON CA 95215 <br /> Work will commence on or about 10/10/2015 for approximately 1-4 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 /> 4/13/2015 <br /> Signature of Applicant-Title Date <br /> M:ICENTRALSERVICESICLERICAVPUBSV.WKVMSTER.PSENCROACHMENTPERMITAPPLICATION.DOC (09113) <br />