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{ y <br /> APPLICATION FOR ENCROACHMENT PERMIT J <br /> PLEASE PRINT: f " l : <br /> Lu 1u ..+--. ^J <br /> Date 09/03/15 OFFICE USE ONLY M <br /> To: San Joaquin County JOB# 13W52--113 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE PACIFIC GAS & ELECTRIC VALID44a <br /> o 2 t,> _ DRIVEWAYS: <br /> (Applicant Name) STREET 6-'r-11 crm <br /> 850 STILLWATER DR AREA TYPE1 pe, e / QUAD <br /> (Mailing Address) FORMS Ss/WIV <br /> WEST SACRAMENTO, CA 95605 NOTES <br /> (City,State,Zip Code) <br /> 925-327-0990 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> PM#31140369 - POLE LOCATION 1 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Hig Right-of-Way on <br /> the NORTH side of E 6TH ST approximately 244 fee ile WEST <br /> of S D ST STOCKTON by performing the following work(description of work): <br /> REPLACING EXISTING 40' WOOD POLE WITH NEW 45' WOOD POLE. NEW POLE WILL BE SET <br /> 1' EAST OF EXISTING POLE APPROXIMATELY 7' SOUTH OF PROPERTY LINE 4' FROM EDGE <br /> -01E CURB) <br /> Work will commence on or about 10/10/15— for approximately 1 <br /> 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 /> A <br /> CONSULTING FIELD ENGINEER 09/03/15 <br /> Signature of Applicant-Title Date <br /> M:(CENTRA.LSERVICES,CLERICAUPU6-SV'NKWASTER.PSIENCROACHMENT PERMIT APPLICATION DOC (0903) <br />