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I <br /> APPLICATION FOR ENCROACHMENT PERMIT S �' t - i Y <br /> PLEASE PRINT: <br /> Ls�� `�,,,i^` -.� �'; , ;, `•!�. <br /> Date 8/27/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 8 °REF# <br /> Department of Public Works APN CR# <br /> r EXP.DATE _ t U0 <br /> HIN-CHUNG ALAN LI , (���( VALID TO ; l(o DRIVEWAYS: <br /> (Applicant Name) STREET LO . X0 V) V,t) <br /> AREA Wkt--+t<T1r, A QUAD 5Vr1 <br /> TYPE cake. qe0k6CAe.TAeJ1;k <br /> (Mailing Address) FORMS <br /> NOTES <br /> (City,State,Zip Code) <br /> 925-327-0990 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See Attached Construction Drawing and Permit Sketch <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the South side of W. RIPON RD. approximately 540 ft feet/mile EAST <br /> of S TINNIN RD. MANTECA, CA 95337, by performing the following work(description of work): <br /> PM#31147593 <br /> NOT#110141785 <br /> POLE REPLACEMENT <br /> Work will commence on or about — forapproximately P " 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 /> f Electric Engineering Estimator 8/27/2015 <br /> Signature of Applicant-Title Date <br /> M8CENi RALSERVICES,CLERICAL,PUB-SV-4YMMASTER.PSIENCROACHMENTPERMRAPPLICATION.DOC (09113) <br />