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- PG&E PM#: 31172965 <br /> .�h�S'•J .�'i+ ,J V i-`. � V X1,.1 1''1 ) 1 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> 23O SED 21 A.� 11: 38 <br /> PLEASE PRINT: <br /> Date 418-'&61'8' OFFICE USE ONLY <br /> To: San Joaquin County JOB# '7 4V -5-Z REF# <br /> Department of Public Works APN CR# <br /> PG&E EXP.DATE (Z-1 -1-5 <br /> VALID f - -( TO - - DRIVEWAYS: <br /> (Applicant Name) STREET <br /> 811 WEST J ST. AREA ?4 QUAD <br /> TYPE Bare <br /> (Mailing Address) FORMS SSGdL✓ <br /> OAKDALE, CA 95361 NOTES <br /> (City,State,Zip Code) <br /> 209-576-6624 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> PLEASE SEE THE ATTACHED CONSTRUCTION SKETCH & TRAFFIC CONTROL PLAN <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the EAST side of CARROLTON RD approximately 165 feet/mite SOUTH <br /> of LOUISE AVE ESCALON by performing the following work(description of work): <br /> TO REMOVE IDLE FACILITIES LOCATED OVERHEAD, IN THE ABOVE LOCATION AND <br /> ON ROTH SIDES OF CARRDI TON RDS 105' NORTIHOF 1 01 USE AVE <br /> Work will commence on or about Sept 1- Sept 2015 for approximately ONE 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 /> 08/18/2015 <br /> MARK C7:WWOMWI R* IFAATOR, PG&E Date <br /> M:ICEMRALSERVICESICLERICALIPUB-SV.WKMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (09/13) <br />