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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 2/4/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB It eLf,-Y),'I' REF f1 <br /> Department of Public Works APN CR 11 <br /> EXP.DATE <br /> PG&E EXP. <br /> TO (�f���!�2��� DRIVEWAYS: <br /> (Applicant Name) STREET ;k C-1- <br /> 4040 WEST LN AREA <br /> TYPE O UAD � <br /> (Malting Address) FORMS <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 42324176 <br /> The undersigned hereby applies for permission to excavate,construct and/or othenvise encroach on County Highway Right-of-Way on <br /> the_ NORTH side of BENTLEY CT approximately 436' feet/mile WEST <br /> of GRANADA LN , LINDEN ,by performing the following work.(description of work): <br /> EXCAVATE(1)4x4 BELLHOLE TO 13EPAIR GAS MAIN <br /> Work will commence on or about 3/1512015 for approximately 30 days. <br /> I,thg.0 deg ed,certify that I a r�e�vner of the respective property,or am qualified to represent the owner and agree to do the <br /> w ik describ 0 above In accor a ce Z211 1w <br /> the rules and regulations of San Joaquin County and subject to Inspection and approval. <br /> /0�ml� <br /> 'i'� 21412015 <br /> Signatu o Applicant-Titlo Date <br /> E'R�35YYY(IASI(RPS tYCfYlFlhl'J,FPL4�5f IMIAIK/I WG�ilf.e, <br /> i <br /> f <br /> f <br />