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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 1/22/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 00 S� REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> PG&E VALID — [5-15 TO — — DRIVEWAYS: <br /> (Applicant Name) STREET <br /> 1 11 OP 4040 WEST LN AREA QUAD Al <br /> TYPE <br /> (Mailing Address) FORMS <br /> STOCKTON, CA 95204 NOTES <br /> (City, State, Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> SEE ATTACHED SKETCH <br /> PM 31065291 <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 Bishop St approximately feet/mile west <br /> of Wilson Wv , Stockton , by performing the following work(description of work): <br /> Excavate 30' in the dirt area on the south side of Bishop St <br /> Work will commence on or about 3/15/2015 for approximately 60 days. <br /> I,the undersigney that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work describ ve in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> rte"; t 1/22/2015 <br /> dirt r <br /> ignature of Applicant-Title Date <br /> E]PUB-SVINKNAASTERPSIENCROACHMENT PERMIT APPLICATION.DOC (01/00) <br />