Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 5/14/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# '-f REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Eugeno Ponce VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET KJdVk tom°— <br /> AREA UAD <br /> 850 Stillwater Drive TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> West Sacramento, CA, 95605 <br /> (City,State,Zip Code) <br /> 925-327-0330 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> l l TO -7 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the P f fi side of MB 16300 N.Ripon RD. 1 PS approximately 580 Feet feet/mile <br /> of French Camp RD. ,by performing the following work(description of work): <br /> REPLACE DETERIORATED POLE. PM 31119017 . Traffic Control Plan will <br /> be implemented in this project. <br /> Work will commence on or about 7/01/2015 for approximately 3 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 /> vy tbq� 5/14/2015 <br /> Si4dature of Applicant-Title Date <br /> M:CENTRALSERACESCLERICALWDRSV.WMMASTER.PSENCROACHMENTPERMRAPPLICATION.DOC(09113) <br />