Laserfiche WebLink
PM#31169543 NOTIF:110393481 <br /> APPLICATION FOR ENCROACHMENT PERMIT V <br /> 3z <br /> PLEASE PRINT: <br /> Date 10/23115 OFFICE USE ONLY <br /> To: San Joaquin County JOB# USZ REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE. <br /> PGE J�Ir `'�J �J lel/-j�,� VALIDTO^�— DRIVEWAYS: <br /> (Applicant Name) STREET 2 U S /a G' e <br /> AREA QUAD 4/LV <br /> 850 STILLWATER DR. TYPE arc <br /> (Mailing Address) FORMS Wky �Zlif <br /> NOTES <br /> WEST SACRAMENTO,CA <br /> City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> ���l <br /> ( I � 61.5 <br /> The undersigned hereby applies for o v te,cD tr t nd/or otherwise encroach on County Highway Right-of-Way on <br /> the side of f�1,1to, approximately feet/mile <br /> of <br /> REPLACE DETERIORATED POLE by performing the following work(description of work): <br /> CONSTRUCTION DRAWING AND PERMIT SKETCH IS A"fTACHED. <br /> 38.201768,-121.511046 <br /> Work will commence on or about _for approximately 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 des"incordancehe rules andregulations of San Joaquin County and subject to inspection and approval. <br /> Signature of Applicant-Title Date <br /> M:ICENTRALSERVICESCLERICAL'AUSSV.NK,NIASTER.PSENCROACHMENTPERMff APPLICATION.DOC (013) <br />