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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 8/18/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATEJ <br /> PG&E r--1 `l <br /> VALID 7- TO C��; r�" ,� DRIVEWAYS: <br /> (Applicant Name) STREET ` l <br /> 4040 WEST LN AREA --QUAD <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 42449181 <br /> The under0ned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the EAS side of S WILSON WY approximately 50' feet/mile NORTH <br /> Of NEWTON RD STOCKTON by performing the following work(description of work): <br /> PG&E MADE TEMPORARY REPAIRS TO AN EXISTING GAS MAIN BY EXCAVATING A 25'x4'TRENCH. PERMENANT REPAIRS <br /> ARE NEEDED AND PLANNED FOR EITHER 8/22 OR 8/29/2015. <br /> Work will commence on or about 8/22/2015 for approximately 30 days. <br /> Y <br /> I, the undersigned,certify that I am t ner of the respec' e property,or am qualified to represent the owner and agree to do the <br /> work described above in ance with rules and regula ons of San Joaquin County and subject to inspection and approval. <br /> _ 8/18/2015 <br /> Signature of Applicant-Title Date <br /> E:IPU&SV.WKIMASTERPSIENCROACHMENT PERMITAPPLICATION.DOC (01108) <br />