Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 6/5/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> PACIFIC GAS AND ELECTRIC EXP.DATE. <br /> VALID TO I-(, fS DRIVEWAYS: <br /> (Applicant Name) STREET —14&5r Al, <br /> 850 STILLWATER DR. AREA 1114 _ QUAD 5 C <br /> TYPE Qce <br /> (Mailing Address) FORMS 14Z 141 Z <br /> NOTES <br /> WEST SACRAMENTO,CA.95605 <br /> (City,State,Zip Code) <br /> 916 760 1904 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> (PLEASE SEE ATTACHMENTS) <br /> The undersigned <br /> de Higned hereby applies for permission excavate,construct and/or otherwise encro572{on County Highway Right-of-Way on <br /> the E <br /> side of EAVE MAapproximately feet/mile EAST <br /> of AUSTIN RD. by performing the following work(description of work): <br /> INSTALLATION OF NEW POLE. <br /> IiJ <br /> 1f <br /> Work will commence on or about _for approximately 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 /> JOE VAHLE(ELECTRIC ESTIMATOR) 6/5/2015 <br /> Signature of Applicant-Title Date <br /> M:ICENTRALSERVICESICLERICAL'PUBSV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (013) <br />