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A,PpLicATTibN'"iVOFZENCROACHMENT PERMIT <br /> PLEASE PRINT: %i;i3L, <br /> II i. <br /> Date 9/28/15 <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7362l15'2— REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE j <br /> Tim North for Pacific Gas & Electric Co VALID To DRIVEWAYS: <br /> (Applicant Name) STREETj <br /> AREA QUAD <br /> 850 Stillwater Rd. TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> West Sacramento CA 95605 <br /> (City,State,Zip Code) <br /> (916) 760-1981 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See attached plans. <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 S. Alpine Rd approximately 710 Feet feeUmile N/E <br /> of East Main St Stockton by performing the following work(description of work): <br /> Replacing rotten utility pole on East side of S Alpine Rd 1 lane shut down only. <br /> Work will commence on or about 9/17/2016 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 /> 2� 1f1)61&1-!6 9/28/15 <br /> Signature of Appli nt-Title Date <br /> E:1PUS-SV.WKIMASTER.PS,ENCROACNMENT PERMIT APPLICATIONAOC(01,08) <br />