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Iv <br /> APPySJffy�Rkff*HMENT PERMIT <br /> PLEASE PRINT: Ot ?T.. O `U311C WORKS <br /> Date 08/08/15 OFFICE USE ONLY <br /> To: San Joaquin County JOB# L)52— REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE j 1—( — 1 <br /> PACIFIC GAS & ELECTRIC VALID 5-( To I DRIVEWAYS: <br /> (Applicant Name) STREET <br /> I ` AREA Fc t�y1 QUAD <br /> VAC K IVaS TYPE <br /> Mailing Address) FORMS S3 14/A/ Z�/ <br /> Frano <br /> NOTES <br /> (City,State,Zip Code) <br /> 925-327-0990 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> PM#31122713 - POLE LOCATION 1 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Wayon <br /> the WEST side of HENRY ROAD approximately 195 fl eetamile NORH <br /> of EAST RIVER ROAD , ESCALON , by performing the following work(description of work): <br /> REPLACING EXISTING 45'WOOD POLE WITH NEW 55'WOOD POLE. NEW POLE WILL BE SET 1'NORTH OF <br /> EXISTING POLE APPROXIMATELY 8'WEST OF PROPERTY LINE (APPROXIMATELY 18' FROM FOG LINE) <br /> Work will commence on or about 09/17/15 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 /> CONSULTING FIELD ENGINEER 08/08/15 <br /> / 5 <br /> Signature of Applicant-Title Date <br /> E:PUB-SV.WKIMASTERPSIENCROACHMEPR PERMIT APPLICATION.DOC (01108) <br />