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APPLICATION FOR ENCROACHMENT PERMIT v <br /> PLEASE PRINT: <br /> Date 9/23/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# Z REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Eugeno Ponce VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA QUAD �S <br /> 850 Stillwater Drive TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> West Sacramento, CA 95605 <br /> (City,State,Zip Code) <br /> 925-327-0330 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> TO* VINOH <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the Left side of sola RD. approximately 20 Feet feet/mile <br /> of E.Mariposa RD. ,by performing the following work(description of work): <br /> Replace deteriorated pole. PM 31139048 . Traffic Control plan <br /> will be implemented in this project. <br /> Work will commence on or about 12/05/2015 for approximately 2 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 /> �ft�116r-p 09/23/2015 <br /> Signature of Applicant-Title Date <br /> EM1PUB-SV.WKWASTERPSIENCROACHMENi PERMITAPPLICATICN.DOC (01108) <br />