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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASEPRINT <br /> Date 10/.19/11 <br /> OFFICE'USE ONLY <br /> To: San Joagwn County JOB# � pd zREF# <br /> Department ofPublic Works APN CR# <br /> EXP:DATE <br /> PG9E (JIM FISXCARO GC LINE DEPT. ) VALID _f-1 l TO __1-2,��� DRIVEWAYS: <br /> {Applicant Name) STREET �. <br /> AREA 0 WD <br /> 4040 WEST LANE TYPE tiC C-- <br /> (Mailing Address) FORMS SS t,j L, <br /> NOTES <br /> STOCKTON, CA. 95204 <br /> (209)942-1780 <br /> (Area Code.-.:Telephone Number) <br /> Sketch(Detailed:plans may be submitted) REFERENCE JOB NO. PM 30764695 <br /> STEVE LAWSON PGBE FOREMAN (530)601-6285 <br /> JIM FISICARO WORK COORDINATOR PGSE @ STUCKTUN (209) 942-1780 <br /> The.undersigned hereby applies forpermission to excavate,,construct and/or otherwise.encroach on County Highway Right-of--Way on <br /> the side ofd.,(Z tea �� approximately 7 feet/mile <br /> of , by performin the followm •work descri tion of work) <br /> ,- <br /> by <br /> 9 P <br /> PGBE WILL AVE .GC TULVER DEPT RAISING TOWERS-ON THE KASSON%LAMMERS 115KV TOWER LINE. WORK <br /> AREA WILL BE FROM LAMMER.S SUB, .LAMMERS RD., TRACY TO. KASSON SUB, KASS N RD:, TR S <br /> WILL BE USED TO DO SOME OF THE WORK ON TOWERS, TRAFFIC PLANS ENCLOSED ,FOR 4003 STONERIDGE DR., <br /> BANTA. STATEWIDE SAFETY..WILL;.PRUVIDE RRK SITE PROTECTION FOR THIS PROJECT. <br /> Work will can_inence on or about 11 1 f 11 for apProxiitiately. 1/31/12 <br /> days. <br /> 1,the undersigned,certify that l am the.ownerof the respective property,or am qualified torepresent the owner and agree to do the <br /> work descnbed above,in accordance kith theroles and regulations of San Joaquin County and subject to inspecti6rr and approval: <br /> Signature of Applicant Title <br /> - Date <br /> F-iMMWX"&ST8UV0CMACHuerrMa.rAPRrAnokooc �+ <br />