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1 <br /> II <br /> APPLICATION FOR ENCROACHMENT PERMIT I <br /> PLEASE PRINT: <br /> Date December 21, 2011 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 2-2, REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 3-1-2d 12 <br /> Pacific Gas& Electric c/o Ajsha Pullin VALID 1/-1`Ul2- TO - -Zo1Z DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA QUAD X <br /> 375 N. Wiget Lane Ste. 200 TYPE e <br /> (Mailing Address) FORMS S 4 JI.�:) <br /> NOTES <br /> Walnut Creek CA 94598 <br /> (City,State,Zip Code) <br /> (925) 323-0904 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See attachments <br /> A <br /> U b072%0 <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 133 ft feeUmile South <br /> of Academy St: - - , by performing the following work(description of work): <br /> Indirect survey of gas pipeline to assess corrosion protection. ' Survey <br /> consists of drilling 1/2 " holes every 10 ' along pipe path where AC is cover. <br /> No excavation required. Please see attached for more details . <br /> Work will commence on or about 2/3/2 012 for approximately 17 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 /> ��12/21/2011/21/2011 <br /> ignature of Applicant-Title Date <br /> E.IPUB-SV.WHIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br />