Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 5/18/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7,�W 52-1$ REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE s S <br /> Eugeno Ponce i'!' �' k; VALID o TO Ib + iS� DRIVEWAYS: <br /> (Applicant Name) STREET 0&�Vkef 9o0d <br /> AREA ! cM QUAD Sf, <br /> 850 Stillwater Drive TYPE Tote- <br /> (Mailing <br /> att(Mailing Address) FORMS ss mow, -29 <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 /> At I <br /> Thegned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the_ side of Wagner Ave. approximately 1300 FT_ feet/mile <br /> of Yosemite AVE ,by performing the following work(description of work): <br /> REPLACE DETERIORATED POLE. PM 31119018 . Traffic Control Plan will be <br /> implemented in this prosect. <br /> Work will commence on or about 07/01/2015 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 /> ':� tbm�—t 05/18/2015 <br /> Sighdture of Applicant-Title Date <br /> M:ICENTRALSERVICESICLERICALWUBSV.WMMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (09113) <br />