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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 2 3005_2_ REF# <br /> Department of Public Works APN _ _ CR# <br /> PG&E EXP.DATE _ S-/$ <br /> VALID TO _ _�1f'-l5_ DRIVEWAYS: <br /> (Applicant Name) STREET Fi-Ail, a ati Lh <br /> 4040 WEST LN <br /> AREA dck1,� QUAD �� <br /> (Mailing Address) FORMS U e ;_> 9 <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 31141133 <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 Franceen Ln ,approximately 66' feet/mile east <br /> of Bennett Dr , Stockton _, by performing the following work(description of work): <br /> Excavate (1)4'x4' bellhole on the south side of Franceen Ln. (2) 3'x3' bellholes on the north side of Franceen, and trench <br /> 12'to install a new gas service to 8506 Bennett Dr. <br /> Work will commence on or about 6/1/2015 for approximately 30 days. <br /> I,the unders' ed,certi at I am the owner of the respective property, or am qualified to represent the owner and agree to do the <br /> work de ed ab in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> '14511 r <br /> -4/2 t <br /> Q�� � w✓cl;a Fc.r <br /> —SWRg <br /> re of Applicant-Title Date <br /> E:1PU&SVWKIMASTERPSIENCROACHMENT PERMIT APPLICATION DOC X01/08) <br />