Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PM#3106 8407 (Please include this#on all invoices and correspondence) <br /> PLEASE PRINT: <br /> Date April 09, 2014 <br /> OFFICE USE ONLY <br /> To: San Joaquin County-Highway Department JOB# j G'V 5 Z REF# <br /> - - <br /> PG&E—Katie Lee/Sergio Tonarelli APN# CRV#-- <br /> (Applicant Name) EXP. DATE S-11114 <br /> VALID/t5/-4 TO '�,/ � DRIVEWAYS: <br /> 1524 N. Carpenter Road STREET n <br /> (Mailing Address) )-O <br /> AREA �'U�O QUAD S C <br /> Modesto, CA,95351 TYPE I lAo 0 FORMS S S <br /> (City,State, Zip Code) NOTES: <br /> 209-576-6598/ Fax: 209 576-6602 <br /> (Area Code—Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> See 0AC'Clke4 <br /> The undersigned hereby applies for permission to excavate, construct,and/or otherwise encroach on County <br /> Highway Right-of-Way on the South side of River Road approximately 569 feet mile <br /> West of Burwood Road , by performing the following work. <br /> (Description of work): Provide (1)4'x4' bellhole(s)at 28672 East River Road in Escalon,to cutoff and plug <br /> existing(1/2" PL)gas service stub. <br /> Work will commence on or about April 21-25, 2014 for approximately 1 Day(s). <br /> I the undersigned certify that I am the owner of the respective property, or am qualified to represent the owner <br /> agree to do the work described above in accordance with the rules, regulations of San Joaquin County and <br /> subject to inspection and approval. <br /> Gas Engineer Estimator April 09, 2014 <br /> SIGNATLN{E F APPLICANT-TITLE DATE <br />