Laserfiche WebLink
S /s 'J <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7-?605;L4 REF# <br /> Department of Public Works APN CR# <br /> Job Owner: Kimberly Van Fleet �y EXP.DATE Z 1 Ilp <br /> Estimator: Adam Vogelaar CC?E VALID 1 1S 0 2 /PDRIVEWAYS: <br /> (Applicant Name) STREET <br /> Sacramento RMC AREA �-jp ,) QUAD lwf� <br /> 850 Stillwater Rd TYPE p .e �e'l�� r►i <br /> (Mailing Address) FORMS S h, <br /> NOTES <br /> West Sacramento CA 95605 <br /> (City, State,Zip Code) <br /> Est phone# : 925 . 327 . 0990 <br /> (Area Code-Telephone Number) <br /> F <br /> tch (Detailed plans may be submitted) <br /> ole Replacement <br /> 31139068 <br /> otif: 110016076 <br /> Location: MB 10406 E.COPPEROPOLIS RD 2/E, STOCKTON <br /> Permit drawing, Construction drawing, and TCP attached. <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 E . COPPEROPOLIS RD <br /> of N. PATRICK RD approximately 136 fJ ee�3f'mileWEST <br /> STOCKTON , by performing the following work(description of work): <br /> REPLACING EXISTING 45 ' POLE WITH NEW 45 ' POLE. <br /> Work will commence on or about Yl ) - f for approximately 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 07/07/2015 <br /> Signature of Applicant-Title Date <br /> M1C=NIRA-SERNCESCLERICAL'.=UE-SVWK'l',IHS?ER.PSIEWPCACH',IEN-PERMITAPPLICATIONDOC (09iSJ <br />