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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> 1 � � � � �� <br /> 1/13/2013 <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 3 ( (1 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 3/0 4 <br /> PG&E VALID j/I /14 TO '3/1114- DRIVEWAYS: <br /> (Applicant Name) STREET IM O Z-14e 4 Va <br /> 4040 WEST LN AREA tock}rx4 QUAD CC <br /> TYPE T-r.enf• A <br /> (Mailing Address) FORMS <br /> STOCKTON, CA, 95204 NOTES <br /> (City,State,Zip Code) <br /> 209-942-1421 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> SEE ATTACHED SKETCH <br /> PM 31033878 <br /> The undersigned hereby applies forpermission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of MARINE AVE approximately 105 feet/mile NORTH <br /> of PRINCETON AVE STOCKTON , by performing the following work(description of work): <br /> TRENCH 40 ' TO INSTALL NEW DEEP WELL ANODE FOR CATHODIC PROTECTION OF PG&E <br /> GAS FACILITIES . <br /> Work will commence on or about 1/1/2014 for approximately 60 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 /> 1e1J1A__ 11/13/13 <br /> Signature of Applicant-Title Date <br /> E:\PUB-SV.WKIMASTERPSIENCROACHMENT PERMIT APPLICATIONAOC (010) <br />