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APPLICATION FOR ENCROACHMENT PERMIT r <br /> 77, <br /> PLEASE PRINT: r. .: <br /> Date 's OFFICEVSE ONLY <br /> To: San Joaquin County JOB# r1-2,)05J,-19 REF# <br /> Department of Public Works APN CR# <br /> �r EXP.DATE 7-/1//`4. <br /> MARCELINO SAMAGUE I f / �� VALID 1,0110115' 0 2 , DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA QUAD = <br /> 850 STILL WATER DR. TYPE tl C G��ynst <br /> (Mailing Address) FORMS S� ttiLc/ <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 /> PG&E WILL REPLACE A POLE,THERE WILL BE GROUND DISTURBANCE(DIGGING)2-3FT WIDE AND 7'DEEP.ATTACHED PLEASE <br /> FIND ASPECTS,CONSTRUCTION DRAWING AND IMAGES OF EXISTING POLE, <br /> PM:31140363 <br /> NOTIFICATION:1109997440 <br /> COORDINATES(37.874276,-121.078129) <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the ROAD Side of 19405 E MARIPOSA RD STOCKTON CA 95215 approximately 1.5 <br /> PP Y feet/mile ml <br /> of CROSSING ST,S VAN ALLEN RD by performing the following work(description of work): <br /> REPLACE DETERIORATED POLE/PM 31140363 <br /> POLE LOCATED MID FIELD OF 19405 E MARIPOSA RD IN STOCKTON CA. <br /> Work will commence on or about 10/10/2015 `- j 3 j lw for approximately 1-4 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 /> 6/26/2015 <br /> Signature of Applicant-Title Date <br /> M',CENTRALSEWCESICLERICAL'P18 SVWMASTER.PSIENCROACHMENT PERMIT APPLICATIONDOC (09/13) <br />