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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 4/14/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# (,S Z REF# <br /> Department of Public Works APN CR# <br /> PG&E EXP.DATE <br /> VALID TO (_5' DRIVEWAYS: <br /> (Applicant Name) STREET s <br /> 4040 WEST LN AREA QUAD b- <br /> (Mailing Address) FORMS ' ' WW <br /> STOCKTON, CA 95204 NOTES <br /> (City,State,Zip Code) <br /> 408-316-1767 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> SEE ATTACHED SKETCH <br /> PM 31144913 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the east side of N Anteros Ave approximately 1076' feet/mile north <br /> of E Minor Ave Stockton _, by performing the following work(description of work): <br /> Excavate(1)4'x4'bellhole to replace gas service to 614 N Anteros Ave, Stockton <br /> Work will commence on or about 5/1/2015 _for approximately 30 days. <br /> I,the und=P06 , <br /> the owner of the respective property,or 3m qualified to represent the owner and agree to do the <br /> work descce with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Pw: r 4/14/2015 <br /> Sle Date <br /> E,IPU&SV. CROACHMENTPERMITAPPLICATION DOC (01108) <br />