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AP'(,0DLIOA=N FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 06/24/15 OFFICE USE ONLY <br /> To: San Joaquin County JOB# ?�0aS REF# <br /> Department of Public Works APN _ _ CR# <br /> EXP.DAIE _ -j - jS <br /> PACIFIC GAS & ELECTRIC VALID jQ - TO -1 — DRIVEWAYS: <br /> (Applicant Name) STREET Floyin 0, <br /> AREA �jn<. Dn QUAD S <br /> 850 S T ILLWATER DR TYPE <br /> JN- <br /> (Mailing Address) FORMS S t4l W P,z <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 /> PM# 31119078 - POLE LOCATION 1 <br /> The undersigned hereby applies for permission to excavate,con 3truct and/or otherwise encroach on County Highway Right-of-Way on <br /> the SOUTH side of W FEDORA RD approximately 40 fee ile WEST <br /> of S LOCKHART RD , FRENCH CAMP ,by performing the following work(description of work): <br /> REPLACING EXISTING 40'WOOD POLE WITH NEW 50'WOOD POLE. NEW POLE WILL BE SET 1'WEST OF <br /> EXISTING POLE APPROXIMATELY 4'NORTH OF PROPERTY LINE (11'SOUTHOF EDGE OF PAVEMENT) <br /> Work will commence on or about � �_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 /> r � ' <br /> C ' CONSULTING FIELD ENGINEER 06/24/1.5 <br /> Signature of Applicant-Title Date <br /> M:ICEMRALSERVICES\CLERICALIPNB-S4.WKI/ASTER.PSIFNCROACHMENTPERfAITAPPLICATION.DOC (09113) <br />