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I Y <br /> APPLICATION FOR:ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 4/4/2014 OFFICE USE ONLY <br /> To: San Joaquin County , JOB# Z36t->5 Z-,C REF# <br /> Department of Public Works APN CR# <br /> EXPDATE, L,- <br /> PG&E VALID DRIVEWAYS: <br /> (Applicant Name) STREET /k <br /> AREA -Srexlt4io QUAD ,—�3 <br /> 4040 West Ln TYPE <br /> Ig <br /> (Mailing Address) FORMS1?,Zq ex <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 submitted) <br /> SEE'.INCLUDED 'SKETCHES <br /> PM 31063538 <br /> The undersigned hereby appliesfor permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> thevarious sideofE 'Munford &.-99 Frontage approximately feet/mile <br /> of Stockton by performing the following work(description of work): <br /> 2G,&E i -, rP viii red to rel gra`t'e R°) ga'_G services ani] (1 ) gas main to P1 Par <br /> Cal—Trans drainage-,•work on:`.E",Mun'ford,. and S Hwy 99 Frontage Rd, Stockton. <br /> Locations: 3904, ;3823.,; '383,9, . 38'07, 3.628, & 3604 E Munford Ave. <br /> 292'9 &' 324.9. S Hwy 99 Front.acre Rd <br /> 1953;."Dr-aka-Ave <br /> Work will commence on or about ,,5/1/2 014 for approximately g n days, <br /> I,the undersigned,certify that l 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 /> 4/4/2014 <br /> Si e o pplicant-Title Date <br /> G N'R I S l.,h�vli <br /> EiPU&SV.WKIMASTER.PSIENCROACHMENT PERMrr APPLICATION.DOC.,(01108) , <br />