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PM: 31140031 <br /> Notification#: 110006797 APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 07-09-2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> William Escobar VALID 10-1 3-1 S TO — DRIVEWAYS: <br /> (Applicant Name) STREET �I�✓►pea <br /> AREA4 QUAD <br /> 850 Stillwater Drive TYPE <br /> (Mailing Address) FORMS ��`�� <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: 31140031 <br /> Notif. 110006797 <br /> Location: a/f ent to 27344 e. sonora rd. 6p s/e <br /> Permit Drawing and Construction drawing attached <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the East side of Sonora rd approximately 4/5 mi feet/mile South <br /> of CA-4 Highway 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 10-13-2015 _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 /> C"Hlliwil(ascobw - Estimating Engineer n7-n9-?015 <br /> Signature of Applicant-Title Date <br /> M10ENTRALSERVICES\CLERICALIPU&SV.N70MASTER.PSIENCROACHMENTPERM(TPPPLICATION.DOC (09113) <br />