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PG&E PM # 31167691 <br /> 5 <br /> rr � I I. �n <br /> [u„ APPLICATION FOR ENCROACHMENT PERMIT <br /> 5 S .t c 8 :a, 1 , I L <br /> PLEASEP_RINT: <br /> Date % OFFICE USE ONLY <br /> To: San Joaquin County JOB REF# <br /> Department of Public Works APN CR# <br /> PG&E - Mark O. Hughes EXP.DATE r z- ► - 15' <br /> VALID TO 12 45- DRIVEWAYS: <br /> (Applicant Name) STREET (GtrPr <br /> CV <br /> AREA �s Gt� �7 QUAD ^S� <br /> � j �a�c� <br /> � 5�1 TYPE <br /> (Mailing Address) FORMS <br /> CA 33 -1l.✓ 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 attached construction drawing, location 1 <br /> and 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 North side of Carter Rd approximately 1,062 feet+n49- West <br /> of La Castella Ln , Escalon _, by performing the following work(description of work): <br /> Installing 1 utility pole —16+ feet north of north fo Ig ine- ugering hole 6 ' deep, <2' dia in dirt (no <br /> disturbance of pavement). <br /> Work will commence on or about —' for approximately days. <br /> 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 /> Mark O. Hughes <br /> Sr ineering 08/12/2015 <br /> Signature of Applicant-Title Estimator Date <br /> PG&E <br /> M1CE14TRALSERVICESICLERICALIPUB-SVWKIIOASTER.PSIENCROACHMEN'r PERMITAPPLICATION.DOG (09113) <br />