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PM: 31147562 <br /> Notification #: 110141755 APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: L i3 <br /> Date OFFICE USE,ONLY <br /> To: San Joaquin County JOB# '73,0o52,1 REF <br /> Department of Public Works APN CR <br /> Job Owner: Kimberly Van Fleet R b- EXP.DATE — I <br /> Estimator' William FsrohAr VALID is- To 4. 0 n, DRIVEWAYS: <br /> (Applicant Name) STREET Ay,.AQ�/ p_r>, <br /> AREA 7-gRe I/ QUAD <br /> 850 Stillwater Drive TYPE <br /> GIC <br /> (Mailing Address) FORMS SS�VW <br /> NOTES <br /> ES <br /> West Sacramento, CA 95605 <br /> (City,State,Zip Code) <br /> 925-327-0990 <br /> (Area Code-Telephone Number) <br /> Sketch(De <br /> tailed plan <br /> s may be submitted) <br /> Pole Replacement <br /> P P <br /> M: 31147562 <br /> Notif. 110141755 <br /> Location: BIRD RD/ AHERN RD IE, TRACY, CA. <br /> Permit drawing, Construction drawing <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the—WEST side of AHERN RD approximately 50' feet/mile east <br /> Of BIRD RD. TRACY CA. by performing the following work(description of—work): <br /> Replacement of deteriorated electric(facility)wood pole. <br /> Work will commence on or abouf R �'1 <br /> for approximately �days7 <br /> pec ive prope y,or am <br /> 1,the undersigned,certify that I am the owner of the respective 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 /> Estimating Engineer 08-13-2015 <br /> Signature of Applicant-Title Date <br /> M:CEf4TW-,LSERIACES',CLERICALTUBSV.Al(�N',hSTER,PS�EN'CROACHMENTPERM[TAPPLiCATtON.00C (0913) <br />