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PM: 31140360 <br /> Notification #: 109997443 APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 07-10-2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 (� 5~� REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> William Escobar VALID l TO - - DRIVEWAYS: <br /> (Applicant Name) STREET IR C4' <br /> AREA QUAD �e <br /> 850 Stillwater Drive TYPE <br /> (Mailing Address) FORMS 5i V141 <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 /> Pole Replacement <br /> PM: 31140360 <br /> Notif. 109997440 <br /> Location: 24323 SKIFF RD 2 W/O <br /> Permit Drawing and Construction drawing <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the north side of Skiff RD approximately 1 mi feet/mile west <br /> of s escalon bellota rd farmington Ca ,by performing the following work(description of work): <br /> Replacement of deteriorated electric(facility)wood pole. <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 /> Chinn cTcab�a - Estimating Engineer 07-10-2015 <br /> Signature of Applicant-Title Date <br /> MiCENTRALSERVICEMCLERICAL1PUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATIONAOC(09;13) <br />