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PM: 31140361 <br /> Notification#: 109997442 APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 07-10-2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# %�yy5 REF# <br /> Department of Public Works APN CR# <br /> William Escobar r EXP.DATE _ S <br /> ��r5 G VALID O—1 _ To — DRIVEWAYS: <br /> (Applicant Name) STREET ,Q <br /> AREA QUAD <br /> 850 Stillwater Drive TYPE <br /> (Mailing Address) FORMS <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 /> Pole Replacement <br /> PM: 31140361 <br /> Notif. 109997442 <br /> Location: C/O MURPHY RD/WILDWOOD RD 2 W/O <br /> Permit Drawing, Construction drawing, and TCP attached. <br /> The undersigned hereby applies for permission to excavate,construct and/cr otherwise encroach on County Highway Right-of-Way on <br /> the north side of_Murphv RD <br /> approximately 520 feet/mile west <br /> of Wildwood rd , Avena Ca <br /> _,by performing the following work(description of work): <br /> Replacement of deteriorated electric(facility)wood pole <br /> -------------- <br /> Work will commence on or about 10-10-2015 --for approximately 30 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 /> 24'1111201c:Txwbm - Estimating Engineer 07-10-2015 <br /> Signature of Applicant-Title Date <br /> M.'CENTRALSER"CESCLERICAL;PU&SY.W1(`.MASTER.PSIENCROACHMENTPERMFr APPLICATION.DOC (04173) <br />