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1 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 13 Sept. 2012 OFFICE USE ONLY <br /> To: San Joaquin County JOB REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 1 !3 <br /> Pacific Gas & Electric Company, PG&E VALID f0 r /I DRIVEWAYS: <br /> (Applicant Name) STREET 1.Zzi gD. <br /> AREA QUAD ' <br /> 850 Stillwater Rd TYPE ML-c- c� <br /> (Mailing Address) FORMS 55 <br /> West Sacramento, CA 95601 NOTES <br /> (City,State,Zip Code) <br /> 916-760-1958 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for germission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the f side of ext 2.n approximately -zo' feet /4*� <br /> Of 411&fF -A e--ry L� rr�, ,by performing the following work(description of work): <br /> Please refer to construction drawings for work locations. <br /> PG&E will be transferring the existing overhead conductors replacing poles, <br /> and replacing/removing/installing down guys as required <br /> Work will commence on or about December 1 st 2012-June 30 2013 for approximately Seven 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 /> D cz�"�p S /'5 <br /> Signature of Applicant-Title Date <br /> EWUB&SVWX WASTERPSDJCROt.CN IJTPMWAPPLMA"DOC p1.44) 1 <br />