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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/12/2016 <br />To:SanJoaquin County <br />Departmentof PublicWorks <br />PG&E <br />(Applicant Name) <br />4040 WEST LN <br />(Mailing Address) <br />STOCKTON,CA 95204 <br />(City,State,Zip Code) <br />408-316-1767 <br />(Area Code -Telephone Number) <br />OFFICE USE ONLY <br />JOB#7 "1tlO'i 2...REF# <br />APN CR# <br />EXP.DATE r;-/-:bVALID DRIVEWAYS: <br />STREET <br />(i-.f -:t TC g-H6 .PiA ddt <br />AREA Stf/r/t::/r:,QUAD <"<:. <br />TYPE • <br />FORMS 5>Wt-V f?."kq <br />NOTES <br />Sketch (Detailed plans may be submitted) <br />SEE ATTACHED SKETCH <br />The undersigned hereby applies for permissionto excavate,construct and/or otherwise encroach on County Highway Right-of-Wayon <br />the SOllth side of W Ellclid Ave approximately 385'feet/mile East <br />of Wisconsin Ave Stn"ktnn,by performingthe foliowing work (descriptionof work): <br />Digging up 4'X4'of asphalt for a service replacement to 3301 W Euclid Ave <br />PM 31218076 <br />Date <br />for approximately _~6~0~days. <br />ure of Applicant -Title <br />rtif I am the owner of the respective property,or am qualified to representthe owner and agree to do the <br />n accordance with the rulesand regulations of San Joaquin County and subject to inspection and approval.