Laserfiche WebLink
PM#31147600 NOTIF:110141784 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> 40 J ti L; 21, <br /> PLEASE PRINT: <br /> ✓ter' 1,t,l Uk <br /> Date 08/18/15 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73w52— REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 1 t( <br /> PGE VALID 12 I /10 TO -i ` /lo DRIVEWAYS: <br /> (Applicant Name) STREET * <br /> AREA "6AW—(:* QUAD _-5-W <br /> 850 STILLWATER DR. TYPE zoe- ,,pp <br /> (Mailing Address) FORMS 5 � <br /> NOTES <br /> WEST SACRAMENTO,CA 95605 <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> f,)Y, L <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the 5voTW side of F?b K,'+• approximately Szxs era+{e 061 5'" <br /> of �/E.4rV.p ,ti44Am6G,g by performing the following work(description of work): <br /> REPLACE DETERIORATED POLE <br /> 37.762211,-121.24449 <br /> 5050 FIG RD.,MANTECA,CA 95337 <br /> Work will commence on or about ' I ", 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 /> RANDALL HATA <br /> 08/18/15 <br /> Signature of Applicant-Title Date <br /> M.VCENTRALSERNCE&CLERICAL'PU9-SV.WKd,MTER.PSENCROACHMENTPERMrr APPLICATION.DOC (09113 <br />