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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 6/17/2014 OFFICE USE ONLY <br /> To: San Joaquin County JOB# -7 3 0 0 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 10 - 15-11-1 <br /> PG&E VALID 7- 1 - 1 `+- TO l 0 • 1 S ) DRIVEWAYS: <br /> (Applicant Name) STREET �N 1 (C)"fih Lin <br /> AREA S'fnr c�2�— QUAD �/E <br /> 4040 WEST LN TYPE <br /> (Mailing Address) FORMS SS/IV 14/ <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 /> PM 31068281 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the SOUTH side of E HILDRETH LN -approximately 90 feet/mile EAST <br /> of HILARY LN , MORADA , by performing the following work(description of work): <br /> EXCAVATE (1)4'x4' BELLHOLE TO REPLACE EXISTING GAS SERVICE TO 5115 E HILDRETH LN <br /> Work will commence on or about 7/15/2014 for approximately 90 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 /> P- 6/17/2014 <br /> gnature of Applicant-Title Date <br /> E WUB-SV.WMMASTER.PSIENCROACHMENT PERMIT APPLICATION DOG (01108) <br />