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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 4/2/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 716052 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 0--(S'�-l5 <br /> PG&E VALID S-IS- 15 TO DRIVEWAYS: <br /> (Applicant Name) STREET r S. -t <br /> 4040 WEST LN AREA QUAD <br /> TYPE 4 <br /> (Mailing Address) FORMS S U <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 31144910 <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 'F'St approximately 393' feet/mile north <br /> of E Stewart St Stockton ,by performing the following work(description of work): <br /> Excavate(1)4'x4'bellhole to replace gas service to 2306 N 'F'St, Stockton <br /> Work will commence on or about S/Z d for approximately 3 days. <br /> I,the undersigned, ' t I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work descri ove ccordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> -�"t",;J ,n4 4/2/2015 <br /> Sign f A -Title Date <br /> EV R.PSIENCROACHMENTPEUBTAPPLICATION.DOC (01/08) <br />