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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 1/13/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# _ 730L REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE l ( S <br /> PACIFIC GAS & ELECTRIC COMPANY VALID -7 —( — TO DRIVEWAYS: <br /> (Applicant Name) STREET -Iotck Tohp <br /> AREA QUAD Air <br /> 850 STILLWATER RD TYPE j�pre <br /> (Mailing Address) FORMS 5S WW <br /> NOTES _ <br /> WEST SACRAMENTO,CA 95605 <br /> (City,State,Zip Code) <br /> 916.760-1980 <br /> (Area Code-Telephone.Number) <br /> Sketch(Detailed plans may be submitted) SEE ATTACHED DRAWINGS. <br /> PG&E 'PM# 31013252. VARIOUS LOCATIONS. <br /> LOC-1.4- & 37 ARE POLE REPLACEMENTS. <br /> LOC-14: 15100/15066 ALPINE RD, 250' N/O <br /> E. KETTLEMAN, 13' E/O FOG LINE. <br /> LOC-37: 11355 JACK TONE RD, 520` N/O LIVE OAK <br /> RD, 22' W/O FOG LINE. <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 by performing the fallowing work(description of work): <br /> Work will commence on-or about'7� Y �5 I-D SII j for approximately UW t<u o w Aj 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 /> zfe�4�� . (��& 1 �/3 1.�-O/s <br /> Sicfiatureof Applicant-Title Date <br /> 6tICEKMKSERVICE&CLERCAL'PUBSV.lVkWASTERPSEtICROAC}MirPFRMIr APPIICATaIDOC(04!13) <br />