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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/25/2014 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E <br />(Applicant Name) <br />4040 WEST LN <br />(Mailing Address) <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 SKETCH <br />PM 31064425 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the WEST side of JOAOUIN CT approximately 355' feet/mile NORTH <br />of REDONDO DR , TRACY , by performing the following work (description of work): <br />EXCAVATE (1) 4'x4' BELLHOLE TO REPLACE GAS SERVICE TO 12010 & 12007 <br />_ JOAQUIN CT, TRACY <br />Work will commence on or about 4 / 15 / 2 014 for approximately 9 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 described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />3/25/2014 _ <br />Signature of Applicant - Title Date <br />E: PUB -SV .WKIMASTERPSIENCROACNMENT PERMIT APPLICATION.DOC (01108) <br />OFFICE USE ONLY <br />JOB #W <br />C-"I>Sz-( REF # <br />APN <br />CR # <br />EXP. DATE <br />2.01 y <br />VALID <br />G{ 1S'-2e,/4TO Z—IS-Zv DRIVEWAYS: <br />STREETc�cuLQ.-V <br />AREA <br />i CA. <br />-c <br />QUAD SSL <br />TYPE <br />Nn�se, <br />FORMS <br />NOTES <br />S5/WW) 9291 1v -L�- C�.�t��•� ')O\kC-y <br />SEE ATTACHED SKETCH <br />PM 31064425 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the WEST side of JOAOUIN CT approximately 355' feet/mile NORTH <br />of REDONDO DR , TRACY , by performing the following work (description of work): <br />EXCAVATE (1) 4'x4' BELLHOLE TO REPLACE GAS SERVICE TO 12010 & 12007 <br />_ JOAQUIN CT, TRACY <br />Work will commence on or about 4 / 15 / 2 014 for approximately 9 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 described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />3/25/2014 _ <br />Signature of Applicant - Title Date <br />E: PUB -SV .WKIMASTERPSIENCROACNMENT PERMIT APPLICATION.DOC (01108) <br />