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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> 5/13/2015 <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> PG&E EXP.DATE fS-�—(S <br /> VALID -ZZ-( TO DRIVEWAYS: <br /> (Applicant Name) STREET /� 4 ze <br /> 4040 WEST LN AREA _5jnQUAD _ <br /> TYPE <br /> (Mailing Address) FORMS _ <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 31139994 <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 Patterson AvP approximately 658' <br /> Of Hwy 26 Stockton feet/mile north <br /> by performing the following work(description of work): <br /> Excavate(2)4'x4' bellholes and bore 29'across Patterson Ave <br /> Work will commence on or about 6/22/2015 for approximately 30 <br /> days. <br /> I,the undersigned, am the owner of the respective property, or am qualified to represent the owner and agree to do the <br /> work describ ove' ccordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> elr Coc>r <br /> hv 41- y <br /> ignat pplicant-Title Date <br /> E1PUB-SVAKIMASTER PSIENCROACHWNT PERMIT APPLICATIONDOC (01/08) <br />