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-"".-"-.- <br />APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/12/2016 <br />To:San Joaquin County <br />Department of Public Works <br />PG&E <br />(Applicant Name) <br />4040 WEST LN <br />(Mailing Address) <br />STOCKTON,CA 95204 <br />(City,State,Zip Code) <br />40B-316-1767 <br />(Area Code.Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />OFFICE USE ONLY <br />JOB#73 (J(!'i2 REF# <br />APN CR# <br />EXP.DATE 6-1-(6 <br />VALID 4-~-16 TO 6-1-/(.DRIVEWAYS: <br />STREET •Falvey U <br />AREA ~~/fknol~ADE f • <br />TYPE • <br />FORMS S5l/v/a.t<zq <br />NOTES <br />. <br />SEE ATIACHED SKETCH <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 Flower St approximately 52'feeVmile North <br />of E Main St Stockton ,by performing the following work (description of work): <br />Digging lip 4'xB'of asphalt for a service replacement to 5555 E Main St <br />PM 31167175 <br />Work will commence on or about _4~/0~1~/=2=0~1=6 ~for approximately _~6~0~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 />Signature of Applicant -Title Date