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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date September 1, 2011 OFFICE USE ONLY <br /> To: San Joaquin County JOB# ,1 <br /> Department of Public Works REF# <br /> APN CR# <br /> EXPPG&E c/o Ajsha Pullin PM#41449679 VALIALI DATE B/ <br /> D 10 DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA QUAD <br /> 375 N. Wiget Lane Ste 200 TYPE <br /> (Mailing Address) FORMS s5 <br /> Walnut Creek, CA 94598 NOTES <br /> (City, State,Zip Code) <br /> (925) 323-0904 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See attached <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the east sideof N. Lower Sacramento Rd approximately <br /> of roadway pp Y feet/mile <br /> Indirect survey of gas by performing the following work(description of work): <br /> consists of drilling 1/221, es throughsasphaltcorrosornconcrete at Survey <br /> of the casin ate at teach end <br /> g. (see attached) <br /> Work will commence on or about End of Sept. /Early Octoberfor approximately 2 <br /> 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 /> nature of Applicant-Title September 1, 2011Date <br /> UB-SV WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION DOC (01/08) <br />