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PLEASE PRINT: <br />Date 2/1/2016 <br />.~.I'i'',:C..:i.~'i\'APPLICATION FOR ENCROACHMENT PERMIT'--._•.' <br />"..~.'.'",'."',',-:-..'j~";.-n -,"I.J\••'_:J - <br />~OFFICE USE ONLY <br />To:San Joaquin County <br />Department of Public Works <br />PG&E <br />(Applicant Name) <br />4040WESTLN <br />(Mailing Address) <br />STOCKTON,CA 95204 <br />(City.State.Zip Code) <br />408-316-1767 <br />(Area Code -Telephone Number) <br />JOB# <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />7~OOfZ <br />h-{-/f:. <br />TO <br />REF# <br />CR# <br />G -/-/6 <br />5 <br />DRIVEWAYS: <br />• <br />Sketch (Detailed plans may be submitted) <br />SEE ATIACHED SKETCH <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-<lf-Wayon <br />the North side of E 6th St approximately 192ft feet/mile East <br />of S Olive Ave Stockton ,by performing the following work (description of work): <br />Digging up 4'x4'of asphalt for a service replacement to 4031 E 6th St <br />PM 31210164 <br />Work will commence on or about 04101/2016 for approximately 60 days. <br />.nature of Applicant.Title <br />property,or am qualified to represent the owner and agree to do the <br />s and regulations of San Joaquin County and subject to inspection and approval. <br />2--12--/r--Date