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' - u <br /> i <br /> APPLICATION FOR ENCROACHMENT P€12�VIfT y „ <br /> PLEASE PRINT: <br /> Date � � <br /> � � "� �� OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE <br /> PACIFIC GAS & ELECTRIC VALID 0 161 is- '' YO :7,11 tip DRIVEWAYS: <br /> f <br /> (Applicant Name) STREET mJ%tg AV6 R * <br /> AREA :5-r0CkT0t.I QUAD Ems <br /> 850 STILLWATER DR -TYPE Pale. � <br /> (Mailing Address) FORMS Li <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#,3/1140381 - POLE LOCATION 1 <br /> /t`�s' �l��lr'��t/l`ti-GS .S�cx-� ,�J�?�et.�+�+�►,r� �� ��l`-°1`;.wc.cs�, �,,�'�� �/�ert <br /> 51 <br /> l.�/�i,� �5 occ��^�-�,ns� ori �_.�e/a�ec��s�o�:r-�. �+�'1j�,���a�cf�r� �.✓f�►al�o.�c�` <br /> ro,+✓e 1� G�ceegS Gft,�'7'���r� �-�e �/®/� �0+2� 1.��'L�. I tr�'1,.�C+►+,. ..��C�'S'S <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the WEST side of DAVID AVE approximately 4 fee ile SOUTH <br /> of E GUERNSEY AVE STOCKTON , by performing the following work(description of work): <br /> _REPLACING EXISTING 45' WOOD POLE WITH NEW 55' WOOD POLE. NEW POLE WILL BE SET <br /> _1' O ITHEAST OF EXISTING POLE APPRO IMATEI v AST OF PROPERT LIN <br /> Work will commence on or about 011,11A _ ` 5 or approximately 1 da s. <br /> Y <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 /> _ -� CONSULTING FIELD ENGINEER 09/17/15 <br /> Signature of Applicant-Title Date <br /> M 10ENTRA.LSERVICFSCLERICALIPUE-SV.iVMMASTER.PSIENCROACHMENTEERM,(T APPLICATION DOC (09113) <br />