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APPLICATION FOR ENCROACHMENT PERMIT <br /> 1 <br /> PLEASE PRINT: <br /> Date 10/30/14 OFFICE USE ONLY <br /> To: San Joaquin County JOB REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> PG&E VALID _ TO 1 L DRIVEWAYS: <br /> (Applicant Name) STREET , ctia1J5 <br /> AREA A#4A1IA QUAD <br /> 4040 West Ln. TYPE 1W4 <br /> (Mailing Address) FORMS 5-31yW. -L'� ?7'GrwA Ai 7 <br /> NOTES <br /> Stockton,CA 95204 <br /> (City,State,Zip Code) <br /> (Area Co e-Telephone Number) ' <br /> Sketch (Detailed plans may be submitted) <br /> These locations have already had repairs completed. <br /> PK*42'zJo►e0o 4q( ,1 (4h Ln. <br /> PM«► g2z0%805- ( 5-101 SV%.A j Ln.) <br /> Pirt:'42Zoi8ol 68480MAranaln A,-, <br /> QM:*/{ZZoi 6 oic. 9027 A(;Idiy 6t) <br /> fai*,qV-00'M ( (Q030 Ffo—k-46re( Lv1) <br /> Pk-k4z2.0►$03 (-*15'Nassase0 Vr.) <br /> PMU422oi804 (537-4 Harw---1 G+-) <br /> ?M## �'�2Zd802 �g'140 bJal nuf Acer-3 jed), <br /> .SCS RTf��IE� RF��'L5 f=d,2. L�a917'1�75 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of approximately feet/mile <br /> of b erforming the following work(description of work): <br /> Prolect locations and paving for PG&E gas leak repair excavation at locations. <br /> �LL hlOL6z /K Dr�T'S1/qut-DEQ <br /> 73— ftU-14-0463 /ter A9✓Ee Aes a <br /> Work will commence on or about for approximately 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 /> 10/30/14 <br /> Signature of Applicant-Title Date <br /> M:ICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER-PSIENCROACHMENT PERMIT APPLICATION DOC (09/13) <br />