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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: PG&E Project#PM 31121841 <br /> Date 03/30/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 300 2_ REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE /S <br /> PG&E - Mark Hughes VALID To -(S-(S DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA QcaL0 QUAD <br /> 811 West J Street TYPE ��p <br /> (Mailing Address) FORMS S S Lt/ /2 Z�-z <br /> NOTES <br /> Oakdale CA 95361 <br /> (City,State,Zip Code) <br /> 209-576-6624 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> PLEASE SEE ATTACHED CONSTRUCTION DRAWING & TRAFFIC CONTROL PLAN <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the WEST side of S VAN ALLEN RD approximately 570' feet/fft�e SOUTH <br /> of STONE RD by performing the following work(description of work): <br /> POLE REPLACEMENT, PARTIAL HAND DIG & AUGER --2' DIA HOLE, 6.5' DEEP <br /> Work will commence on or about BETWEEN 5/26/2015 & 5/29/2015 for approximately '/2 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 /> MARK O. HUGHES <br /> � PG&E ESTIMATING ENGINEER (E) 03/30/2015 <br /> Signature of Applicant-Title Date <br /> MCEIJTRALSERVICESICLERICALIPUBSV.WKWASTER.PSIENCROACHMENT PERMIT APPLICATION DOG (03/13) <br />