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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 3/8/2014 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 6. (5 4- <br /> PG&E VALID _� ?i/j4 TO DRIVEWAYS: <br /> (Applicant Name) STREET 4/1,0 1 <br /> AREA "d AM QUAD <br /> 4040 WEST LN TYPE <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 SKETCH <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the NORTH sideof ALLEY N/0 HWY 88 approximately 66 ' feet/mile E/0 <br /> of 2ND ST ' CLEMENT by performing the following work(description of work): <br /> EXCAVATE (1) 4 'x4 ' BELLHOLE TO REPLACE GAS SERVICE TO 18633 HWY 88, CLEMENTS . <br /> PM 31061805 <br /> Work will commence on or about 3/17/2014 for approximately 5 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 /> 3/8/2014 <br /> Signature of Applicant-Title Date <br /> E.PUB-SVWNIMASTER.PSIENCROACHMENTPERMITAPPLICATION.DOC (07108) <br />