Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT ' <br /> PLEASE PRINT: l <br /> Date _� I W__ S OFFICE USE ONLY <br /> To: SanJoaquin County JOB REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 2 t t(� <br /> Tim North for Pacific Gas & Electric Co. VALID 10 i5- t TO 2 t 10 DRIVEWAYS: <br /> (Applicant Name) STREET I' <br /> AREA /_01> QUAD "Al <br /> 850 Stillwater Rd TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> _West Sacramento, CA, 95605 <br /> (City,State,Zip Code) <br /> (916) 760-1981 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See attached plans. <br /> f I(_a q <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the East side of Devries goad approximately .46 miles feet/mile South <br /> of West Sargent Road , , by performing the following work(description of work): <br /> Replacing rotten pole on East side of Devries Rd. 1 lane shut down only. <br /> Work will commence on or about __,vim IQ))�� ) ` for approximately 1 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 /> ?:e:4"_66tiJe -Electric Estimator, PG&E 8/17/15 <br /> SigiOture of Applicant-Title Date <br /> E:,PU&SVRXWASTEkP&ENCROACHMENT PERMIT APPIICATIONDOC (01,%I <br />