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PM: 31110340 <br />Notification#: 109997459 APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 07-09-2015 OFFICE USE ONLY <br />To: San Joaquin County JOB# REF# <br />Department of Public Works APN CR# <br />r EXP.DATE S ( SWilliamEscobarVALID u—W- — ITO _ _I DRIVEWAYS: <br />Applicant Name) STREET <br />AREA dUAD <br />850 Stillwater TYPE ecu <br />Mailing Address) FORMS 5 5° W/ry P, <br />NOTES <br />West Sacramento, CA 95605 <br />City,State,Zip Code) <br />925-327-0990 <br />Area Code-Telephone Number) <br />Sketch(Detailed plans may be submitted) <br />Pole Replacement <br />PM: 31140340 <br />Notif: 109997459 <br />Location: 7066 MOBLEY RD 4P N, Stockton <br />Permit Drawing, Construction drawing, and TCP Attached <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way ontheEastsideofMobleyRDapproximately615'feet/mile South <br />of Right hand turn on Mobley RD Stockton by performing the following work(description of work): <br />Replacement of deteriorated electric(facility)wood pole. <br />Work will commence on or about 10-10-2015 for approximately 30 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 />ClVillimn Cu,"b r - Estimating Engineer n7-n9-2015SignatureofApplicant-Title Date <br />MICENTRALSERIACESICLERICALIPLSSV.WIMIASTER.PSIENCROACHMENTPERMrrAPPLICATION.DOC (0813(