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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 1/3/2013 OFFICE USE ONLY <br /> To: San Joaquin County JOB Z-0 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE /3 <br /> PG&E/ Bobby Angelov VALID / /3 / DRIVEWAYS; <br /> (Applicant Name) STREET <br /> AREA p QUAD <br /> 2700 Ygnacio Valley Rd. STE 210 TYPE 1?a16. <br /> (Mailing Address) FORMS k/ 2 <br /> NOTES <br /> Walnut Creek, CA 94598 <br /> (City,State,Zip Code) <br /> 925-459-2142 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) Atkins Rd <br /> DIG SITE <br /> type creek <br /> 1200' <br /> ' .4((413013 Stampede Rd N <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 Atkins Road approximately 12001 feet/mile <br /> of ,by performing the following work(description of work): <br /> Excayatei&l X �W bell hole to expose the natural qas pipeline and laerfo <br /> m <br /> r)n t-hP Past- di'rt-. ahc»a 1 df--r c)f At-kin-q Rd - <br /> Work <br /> d _Work will commence on or about 1/14/2 013 for approximately 5-8 days days. <br /> 1,the undersigned,certify that 1 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 /> Signat of Applicant-Title Date <br /> EtPUMV.VlK%MTERPSOICROACHlAEtf PFRISTAPPLICATIOH.DOC(BINS) <br />