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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />•DRIVEWAYS: <br />• <br />• <br />OFFICE USE 9NL Y <br />JOB #.1?IJ05'j -lP <br />APN <br />EXP.DATE --'-'-~,+,-'"+~~+---+c--VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />02/04/2016Date <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 />408-316-1767 <br />(Area Code -Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />SEE ATTACHED SKETCH <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br />the South.side of Elvin Avenue approximately 231'feel/mile West <br />of N.Cardinal Avenue ,Stockton ,byperformingthefollowingwork(descriptionofwork): <br />Excavate (1)4'X4'bellhole to replace existing gas service to <br />5326 Elvin Avenue,Stockton. <br />PM 31210161 <br />Work will commence on or about 04/01/2016 for approximately 60 days. <br />.~Title <br />ner of respective property,or am qualified to represent the owner and agree to do the <br />ules and regulations of San Joaquin County and subject to inspection and approval. <br />02/04/2016 <br />Date <br />E:IPU8-SV.WKlMASTEItPSIENCROACIUI.ENr PERMIT APPLICATION.DOC (01IOB)