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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRIML <br />Date '4) l ` <br />10 San Joaquin County <br />Dopartmenl of Public Works <br />Pacific bas 8 Electric <br />(Applicant Name) <br />3136 Boeing Way, Stockton <br />(Mailing Address) <br />Stockton, Ca, 95204 <br />(City, Smote, Tap Code) <br />408-31611767 <br />_ <br />(Area Code - Telephone Number) <br />STDIVPERMITS@pge com <br />(Email Address) <br />OFFICE USE ONLY <br />JOB # REF # <br />APN — — CR # <br />EXP DATE <br />VALID _ TO DRIVEWAYS. <br />STREET <br />AREA QUAD <br />TYPE - -- -- - - -- — - - -- , ------ <br />FORMS <br />NOTES <br />Sketch (Detailed plans may be submitted) 1 <br />1- <br />I <br />T <br />-7 f h <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the side of approximately ifeeUmile J <br />of Q 1 'i `� by performing the following work (description of work): <br />Work will commence on or after <br />for approximately 180 <br />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 />�'SigAWNVof Applicant - TV& Date <br />