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PLEASE PRINT: <br />-,.:,',:\\':D _,';';'"",.•,'0 lHi 'I '(Sf.l-l ;U..vU'"" <br />APPLICATION FOR ENCROACHMENT PERMIT ,t15 [i;::C-8 Pi1 \:!19 <br />C-1,"(;1 i-l'iO;:KS8Z?T ."u -v • <br />850 STILL WATER DR. <br />(Mailing Address) <br />WEST SACRAMENTO,CA 95605 <br />Date <br />To: <br />PG&E <br />10/31/15 <br />San Joaquin County <br />Department of Public Works <br />MARCELINO SAMAGUEY <br />(Applicant Name) <br />OFFICE USE ONLY <br />73005 2-, <br />JOB#REF # <br />APN CR# <br />EXP,DATE 6-/,/6 <br />VALID 2-2..9-(6 TO 6-/./0 DRIVEWAYS: <br />STREET nj::ra:Sf • <br />AREA QUAD 4/1,1 • <br />TYPE fsor$w • <br />FORMS R)9 <br />NOTES <br />(City.State.Zip Code) <br />(925)327-0090 <br />(Area Code -Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />PG&E WILL REPLACE A POLE.THERE WILL BE GROUND DISTURBANCE(DIGGING)2.3FT WIDE AND 7'DEEP.ATTACH EO PLEASE <br />FIND ASPECTS.CONSTRUCTION DRAWING AND IMAGES OF EXISTING POLE. <br />PM:31170020 <br />NOTIFICATION:110417164 <br />COORDINATES (38.22746,.121.42583) <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br />the ROAO side of 8835 W PINE ST THORNTON CA approximately 600 feet/mile FT <br />of CROSSING STTHORNTON RD ,by performing the following work (description of work): <br />REPLACE DETERIORATEO POLE!PM 31170020 <br />POLE LOCATED OUTSIDE PROPERTY 8835 W PINE ST THORNTON CA 95686 <br />Work will commence on or about 2113/15 TO 05127/16 for approximately 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 />1J1A~AJO S4J114?CI~ <br />Signature of Applicant.Tithr <br />NAME:MARCELINO SAMAGUEY <br />10/31/15 <br />Date