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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB REF <br /> Department of Public Works APN R <br /> ED ARROYO (PG&E) EXP.DATE <br /> VALID to DRIVEWAYS: <br /> (Applicant me) STREET <br /> 850 STILLWATER RD AREA LJN]�� QUAD _tJS <br /> TYPE Le <br /> (Mailing Address) FORMS <br /> W. SACRAMENTO, CA 95605 NOTES <br /> (City,State,Zip Code) <br /> 916-760-1945 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> 8 POLES WILL BE REPLACED FROM EAST SIDE OF N, CLEMENTS RD GOING EAST ON <br /> FRAZIER RD. SOUTH SIDE OF FRAZIER RD. JOB IS ALSO TO RECONDUCTOR 4,878, <br /> OF 4AR WITH NEW 2AR. PLEASE SEE CONSTRUCTION SKETCH FOR WORK DIRECTIONS. <br /> PM 30977169 <br /> The undersigned hereby applies for permission tnexcavate,construct @ndlorotherwise encroach OUCounty Highway h�O�VV8yOn <br /> the side of ~ ~ <br /> of by performing the following work(description of work): <br /> Work will commence on or about 11-01-15 _--for approximately 50 days, <br /> [Umdersignad mthe owner ofthe respective proport�nramqua|i�edknn»p�s8nLthe owner and agree h)dnthe <br /> wm�d�chbndabove inaccordance nKh� � <br /> eno|enandgu�Uonoof 'nJoaquinCnunhymndoubjocthainspeutionoodappmwd, <br /> ESTIMATOR07-03-15 <br /> Signature of AppWant�Title Date <br />