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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> 401536 <br /> Date March 19, 2014 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN _ CR# <br /> EXP. DATE <br /> e- �J VVALID 17)4 TO 7/157114 <br /> !S 6{ DRIVEWAYS: <br /> (Applicant Name STREET �U�i►/E+�,P.R .01 DAY1S An <br /> !� AREA QUAD A1, <br /> G' L;' TYPE �3Et� 1loL�, �ac6ti7ss�i�ui�E� BoX. <br /> (Mailing Addre ) FORMS Ss/s„rj✓, ,G.y9� jrE,vc �rr�„ ,yQz,�y <br /> NOTES <br /> San Ramon, CA 94583 <br /> (City, State,Zip Code) <br /> (925)244-3178 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) See enclosed drawings.. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the Davis Rd. at W. Turner Rd. approximately <br /> feet/mile of , , by performing the following work <br /> description of work): Excavate to uncover gas transmission line, to attach corrosion prevention wires and trench to connect <br /> the wires to a pedestal. <br /> PG&E.Job Estimate No 41989125 <br /> Work will commence on or about April 1,2014 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 /> f March 19, 2014 <br /> 'LUl.E'iZL <br /> Signature of Applicant-Title Date <br /> MICENTRALSERVICESICLERICALIPUS-SV.WKWASTER.PSIENCROACHMENT PERMIT APPLICATIONDOC (09113) <br />