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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 1/22/2014 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7.36&5Z- REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE V104 4 <br /> PG&E VALID Z 3 14 TO 3 S DRIVEWAYS: <br /> (Applicant Name) STREET A0A V 0%4eAyrA4' <br /> AREA -,y,t<7y0 QUAD $� <br /> 4040 WEST LN TYPE CZ - l3EGLk6arc5" Iry �7I2r <br /> (Mailing Address) FORMS <br /> NOTES <br /> STOCKTON, CA 95204 <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 31050916 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the WEST sideof Hwy 99 FRONTAC'E RD approximately 490 ' feet/mile SOUTH <br /> of MARIPOSA RD , STOCKTON , by performing the following work(description of work): <br /> EXCAVATE (1 ) 4x4 B ,T,T,HOT, , TO TN TAT T NEW SERVICE AND EXCACATE (1) 4x4 <br /> BELLHOLE TO CUT OFF OLD SERVICE TO 2463 MARIPOSA RD FOR REALIGNMENT OF <br /> THF FRnNTAGE RD- <br /> Work <br /> D_Work will commence on or about 2/3/2014 for approximately 3 0 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 describe ve in accordance with th rul and regulations of San Joaquin County and subject to inspection and approval. <br /> 1/22/2014 <br /> Si App scant-Title Date <br /> E:IPUB-SV.WKIMASTER.PSIENCROACHA,£NT PERMIT APPUCATION.DOC (01100) <br />