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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 1/24/2013 OFFICE USE ONLY <br /> To: San Joaquin County JOB# ��LY�,�✓a-�p REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> PG&E VALID 1 133 T6 DRIVEWAYS: <br /> (Applicant Name) STREET <br /> 4040 West Lane AREA ` 9UAD E <br /> TYPE <br /> (Mailing Address) FORMS <br /> Stockton, CA 95204 NOTES r1 J <br /> (City,State,Zip Code) <br /> 209--942--1421 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See Attached <br /> PM 30950998 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the W side of Atkins Rd approximately 500 feet/inile S <br /> of Hwy_ 88 Lo cke f ord ,by performing the following work(description of work): <br /> Excavate 30' across Atkins Rd. and 60' along the west side of Atkins Rd. <br /> Work will commence on or about 8/1/2013 for approximately 30 days. <br /> 1,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 ab e 1 ordance ith t rules and regulations of San Joaquin County and subject to inspection and approval. <br /> 1/24/2013 <br /> wat of Ap cant Title Date <br /> E_1PUBSV.WKV ASTE"S1E14CROACHA€NTPB;19TRPPLICAiION.DOC(01W) <br /> i <br /> i <br /> I <br /> I <br />