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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 09/16/11 OFFICE USE ONLY <br /> To: San Joaquin County JOB REF 4 _ <br /> Department of Public Works APN CR 9 <br /> EXP.DATE <br /> Pacific Gas & Electric Company VALID T, RIVEWAYS: <br /> (Applicant Name) STREET /oyl <br /> 850 Stillwater Rd AREA UADTYPE <br /> (Mailing Address) FORMS .i <br /> NOTES <br /> West Sacramento, CA <br /> (City,State,Zip Code) <br /> (916) 760-5363 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See Attached - PM 30810886 - Across From 5296 Armstrong Rd, Stockton <br /> (38.08695, -121.25183) <br /> i <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the South side of Armstrong Rd approximately west feet/mile <br /> Of Mundy Lane by performing the following work(description of work): <br /> Replace pole & transformer. <br /> Work will commence on or aboutd /Y 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 described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval, <br /> Michael Reeves - Electric Engineer 09/16/11 <br /> Signature of Applicant-Title Date <br /> tit!;In�.\r.l1.1;1'VLIM'A.FY_r:A.L!,.Kr, :0"e., <br />