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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> 2: 0 O <br /> Date September 2, 2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# <br /> Department of Public Works APN <br /> EXP,DATE <br /> Summit Line Constriction, Inc. VALID -[ - TO DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA QUAD __ <br /> 875 S. Industrial Parlcw TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> Heber City, UT 84032_ _ <br /> (City,State,Zip Code) <br /> 435-657-0721 ext. 201 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> See Attached <br /> Note: The distaince from the edge of the asphalt to 5 center of pole 9 is 17.8 feet <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the SE side of Mossdale Rd. approximately 100' feet/mile 0 <br /> of work off the shoulder of the read ,by performing the following work(description of work): <br /> Summit Line <br /> SumConstruction,Inc. is a power line contractor and have been selected by Lathrop Irrigation District <br /> and River Island Development to build approximately 6000ft of double circuit 115kV transmission Fine. <br /> Attached are the drawings delineating the locations, size, and scope of said project. Summit Line will not be <br /> cutting any asphalt nor excavating in the roadway. All excavation activities for poles placement will be <br /> performed off the side of the road iii the designated utility easement. Lines will run overhead <br /> Work will commence on or about October 15 2015 for approximately 45 —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 /> Andrew Hubbard, GM_ September 2, 2015 <br /> Signature of Applica t-Title Date <br /> E.OPUS-SV.WKWASTER.PSIENCROACNAIENTPER&IITAPPUCATION.000 (01109) <br />