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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 12/17/12 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE / /� It A <br /> Pacific Gas & Electric CO: C/O Michael Reeves VALID to O 7////)r DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA Cld QUAD 005 <br /> 850 Stillwater Rd TYPE QCG <br /> (Mailing Address) FORMS <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 /> PM 30952357 - Location 1 <br /> Address : 1 pole north of 448 S . Los Angeles Ave, Stockton <br /> Replace joint pole <br /> See attached sketch <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the east side of S Los Angeles Ave approximately 271 feet feet/mile south <br /> of W Sonora St , , by performing the following work(description of work): <br /> Replace joint pole at specified location. <br /> Work will commence on or about 06/27/2013 for approximately 3 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 12/28/12 <br /> Signature of Applicant-Title Date <br /> E:IPUB-SV.WKIMASTER.PSIENCROACHMENTPERMIT APPLICATION.DOC (01/08) <br />