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., <br />APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />OFFICE USE ONLY <br />JOB#7?0052.-REF#. <br />APN CR# <br />EXP.DATE 0 1-(6 <br />VALID 4--{-/6 TO ~rl-IG DRIVEWAYS: <br />STREET Cr2Uf1trr y'([IIb • <br />AREA ~r/:!feQUAD C L • <br />TYPE • <br />FORMS 5>WW £>9 <br />NOTES <br />To:San Joaquin County <br />Department of Public Works <br />ePG&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 />Date FEBRUARY 3,2016 <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 sideof COUNTRY CLUB BLVD approximately 210'feeVmile EAST <br />of LAKEWOOD DR STOCKTON,by performing the following work (description of work): <br />EXCAVATE (1)4'x4'BELLHOLE AND (1)46'BORE TO REPLACE EXISTING <br />GAS SERVICE TO 3157 COUNTRY CLUB BLVD <br />PM 31214929 <br />Work will commence on or about MARCH 1 2016 for approximately 60 days. <br />e respective property,or am qualified to represent the owner and agree to do the <br />es and regulations of San Joaquin County and subject to inspection and approval. <br />Signature of Applicant -Title <br />FEB 3,2016 <br />Date <br />E:\PUB-SV,WKlMASTERPSIENCROACHMENT PERMITAPPLICATION,DOC (Olm)