Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 6/25/2015 OFFICE USE ONLY <br />To: San Joaquin County JOB# '730 0 REF# <br />Department of Public Works APN CR# <br />PG&E EXP.DATE S <br />VALID 10-10-15 TO l (—j —(s DRIVEWAYS: <br />Applicant Name) STREET L/anA l(eh c_ _ <br />850 STILLWATER DR. AREA tjnok.-, QUAD S E <br />TYPE Sy-Affi C 14-Aro( ne la(,e C <br />Mailing Address) FORMS s {y <br />WEST SACRAMENTO, CA 95605 NOTES <br />City,State,Zip Code) <br />Area Code-Telephone Number) <br />Sketch(Detailed plans may be submitted) <br />The undersigned hereby applies for permission to excavate,construct andfor otherwise encroach on County Highway Right-of-Way ontheRIGHTsideofHWY4approximatelyfeet/mile <br />of by performing the following work(description of work):REPLACE DETERIORATED POLE; MAKE MINOR EXCAVATION WITHIN COUNTY RIGHT-OF-WAYS <br />EXCAVATION SHALL NOT EXCEED 35SQ FT IN AREA AND NOT GREATER THAN 6 LINEAR FT IN LENGTH <br />Work will commence on or about 10/10/2015 for approximately 1-4 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 />6/25/2015 <br />Signature o Applicant-Title Date <br />E:IPDB-SV.WKiMASTER.P&ENCROACHMENTPERh11TAPPLICATION.DOC(01108)