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PM 74001625 (R-705) APPL!CAT!O~J FOR ENCROACHMENT PERMIT PLEASE PRINT: Date 211111 To: San Joaquin County Department of Public Works PG&E -Nicole Merritt (Applicant Name) 6121 Bollinger Canyon Rd., BR124D (Mailing Address) San Ramon, CA 94583 (City, State, Zip Code) . 925-244-3815 (Area Code -Telephone Number) JI\ )_ W,() Sketch (Detailed plans may be submitted) plan submitted OFFICE USE ONLY JOB# 7?_{)0>2= REF# APN CR# EXP.DATE f .-/-i7 VALID ){--( -2 TO 6 -1:; / 7 STREET l.-0,.J,'YI IJ1 () I/' f /<. ' AREA /_. -'2 / v QUAD ~ t1/ TYPE ·-r-,,,.., ~ ~ c.h FORMS NOTES DRIVEWAYS: * * * The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on the both (east&west)side of South Lammers Rd approximately 3000 feet · feel/mile south of Valpico Rd -------~ by performing the following work (description of work): to excavate 50'x5' trench across S Lammers Rd and set up traffic control. Trench will cross entire width of right-of-way on S Lammers. Trench will be performed in two sections to allow through traffic. Work will commence on or about __ 3_/_24_/_17 ___________ for approximately ___ s_o ______ days. 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 work described above in accordance with the rules and re ulations of San Joaquin County and subject to inspection and approval. U/\ I U)lz O _2_11111 __ _ ~nature of Applicant -Title Date M:\CEIITRALSERVICES\CLERICALIPUB-SV.WK\MASTER.PS\EMCROACHMEHT PERMIT APPLICATION.DOC (09/13)