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PLEASE PRINT: APPLICATION FOR ENCROACHMENT PERMIT <br /> 10/22/2014 <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 6J���3Z,G REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE `�.f�-Z 6/,,S-- <br /> PG&E VALID 1-I L-ZBIy TOt 2.- I,2e,)/,� DRIVEWAYS: <br /> (Applicant Name) STREE- R <br /> 4040 WEST LN AREA QUAD <br /> TYPE fsle_\�lli \vim. �}- <br /> (MailingAddress) FORMS S510Q.(Zq <br /> STOCKTON, CA 95204 NOTES <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 31099194 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the north side of Brandt Rd -_approximately 560' feet/mile east <br /> of Locke Rd Lockeford , by performing the following work(description of work): <br /> Excavate (1)4'x4' bellhole, in the dirt, to replace gas service to 11701 Brandt Rd, Lockeford. <br /> PM 31099194 <br /> Work will commence on or about 11/17/2014 for approximately 60 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 /> 10/22/2014 <br /> Sign ure of Applicant-Title Date <br /> EJPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01M) <br />