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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> ..i <br /> Date 10/24/11 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 3c�S'L-1 b _ REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas & Electric Company VALID ! /2 I !Z / JZ _ DRIVEWAYS: <br /> (Applicant Name) STREET R sra4 4 <br /> AREA QUADW <br /> 850 Stillwater Rd TYPE � <br /> (Mailing Address) FORMS lvZJ <br /> NOTES <br /> West Sacramento, CA , 95605 <br /> (City, State,Zip Code) <br /> 916-760-5363 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See attached sketch. Replace: pole on north side of Armstrong rd near 4180 Armstrong Rd, <br /> Stockton. <br /> Wm#3o&v 8g4 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach n County Highway Ri ht-of-Way on <br /> the 140P--rH side of �2wis-TPG t2D approximately <br /> of Y21 tck,E G P�rE ;ev, by performing the following work(description of work): <br /> Work will commence on 6r about_ l /2 for approximately. JAV days/ <br /> Jr <br /> I,the undersigned,certify that I am er of the respective property,or +qualified to represent the owner and agreee to do the <br /> work described above in accordance with the ru Fs-anns o San Joaquin County and subject to inspection and approval. <br /> Michael Reeves - Sr Engineering Estimator - Electric 10/24/11 <br /> Signature of Applicant-Title Date <br /> �:°U�Sv t'!F:'.6tS"EF..FSbt.�lG4q;l.7EP1i PFhfAI;hFF' CA.!IGI.GC;C;Oi,f7Sj <br />