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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: 4-11Uzo q� r ( �� n f <br /> Date 1/7/14 i OFFICEUSEONLY <br /> To: San Joaquin County JOB# 7 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE --� L <br /> Jordan McKay (PG&E) VALID 6/7 , � _ TO t DRIVEWAYS: <br /> (Applicant Name) STREET J } <br /> AREA 1 QUAD <br /> 2730 Gateway Oaks TYPE r .241C f <br /> 124, 04 INI <br /> (Mailing Address) FORMS <br /> sacramento CA, 95833 NOTES <br /> (City,State,Zip Code) <br /> 916-296-6684 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Due to the scope of this project, I have provided an attached list of locations as well as a generic <br /> Traffic Control Plan for those locations. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the North side of Jahant Rd approximately feet/mile <br /> of by performing the following work(description of work): <br /> PG&E will be performing tree removals alonq Jahant and Breulla Rds along the Gas Transmission <br /> 120-16ne. This work is being perforrned to insi ire the safe operation of the pip-lone s <br /> I IL inspections fi-oni the air. <br /> Work will commence on or about 1/14/14 for approximately 2-3 weeks 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 /> Jordan McKay-PG&E Land Consultant 1/7/14 <br /> Signature of Applicant-Title Date <br /> M:ICENTRALSERVICESICLERICALIPUBSV.WKWASTER.PSIENCROACHMENTPERMITAPPLICATION.DOC (09113) <br />