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,.-.~:'~'T [)F F ;":,t}-_t ,.,- <br />OF~ICE USE ONLY <br />JOB#13005;).~~REF# <br />APN CR# <br />EXP.DATE 1ft 1l:t#hteVALID DRIVEWAYS: <br />STREET •,,Nfl 1~'I <br />AREA Srt!C/c:tr-N QUAD 1:35 • <br />TYPE ~'b~~.•FORMS :Wt:lJ.1Z-?""7,.-t/1".&4/klIMc7 <br />NOTES <br />':,'L,t J ;.-\-•••:,~:,:"I-~'I <br />APPLICATION FOR ENCROACHMENT PERMP'rf,N j':';r,l<',;;cel',j , <br />.2illli FEB Z 4 Yr,2:\2 <br />Date 02/01/2016 <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 />408-316.1767 <br />(Area Code -Telephone Number) <br />PLEASE PRINT: <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 Dana Avenue approximately 370'feet/mile West <br />of N.Cardinal Avenue ,Stockton ,by performing the following work (description of work): <br />Excavate (1)4'X4'be11ho1e to replace existing gas service to <br />5324 Dana Avenue,Stockton. <br />PM 31209923 <br />Work will commence on or about 04/01/2.QL6 ..for approximately 60 days. <br />I,the undersigned,certify thatj..a~ectlve prop~rty,or am qualified to represent the owner and agree to do the <br />work descnbed above in c6rdance w rules and regulations of San Joaquin County and subject to Inspection and approval. <br />02/01/2016 <br />Date <br />E:\PUB-SV,WKlMASTERPS\ENCROACHMENT PERMIT APPLICATION.DOC 101108)