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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 07/02/15 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 3 00 �;Z REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE -Ili—� <br /> PACIFIC GAS & ELECTRIC VALID 7-1 ;7- 1s TO Jp -1S'- LS DRIVEWAYS: <br /> (Applicant Name) STREET _ lVl xn ch a <br /> PlLa91� *_ <br /> AREA aZ k f0h QUAD C <br /> 850 STILLWATER DR TYPE <br /> (Mailing Address) FORMS g 5 w /22-0/ <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 /> LOCATION 1 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highwa Right-of-Way on <br /> the WEST side of MANCHESTER AVE approximately 25 fee ile NORTH <br /> of N COUNTRY CLUB BLVD STOCKTON _,by performing the following work(description of work): <br /> REPLACING EXISTING 40' POLE WITH NEW 45' POLE. NE:W POLE WILL BE SET V NORTHWEST OF <br /> EXISTING POLE AND APPROXIMATELY 6' EAS*F OF THE PROPERTY LINE. A NEW ANCHOR WILL BE <br /> INSTALLED APPROXIMATELY 13' NORTHWEST-OF NEW POLE. <br /> Work will commence on or about_ l , 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 /> ; d' J CONSULTING FIELD ENGINEER 07/02/15 <br /> Signature of Applicant-Title Date <br /> M:ICENTRALSERVICESICLERICALIPUBSV.WKWASTER.PSIENCROACH6-,T PERMIT APPLICATION.00C (09113) <br />