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PLEASE PRINT: <br />._'.'../~l <br />APPLICATION FOR ENCROACHMENT PERMIT S:.;',;j t,::lil:,'C[,"_;,;i Y <br />2[110 ..1,1:132 .~r.;S:ot. <br />-,;:;),-"..~_.;~~"....."-~.~..- <br />OFFICE USE ONLY .~...'.•.,.v f\;\,J <br />JOB#7?N)5'2 REF# <br />APN CR# <br />EXP,DATE f-~-16VALID4--~C TO 6-(-/6 DRIVEWAYS: <br />STREET ~pr <br />• <br />AREA W£•SQUAD <br />TYPE (t!ff/i&.cr T0encE <br />• <br />FORMS <br />NOTES <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 />Date 1/27/2016 <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-of-Way on <br />the East side of S Wagner approximately 383ft feet/mile South <br />of E Washington Stockton ,by performing the following work (description of work): <br />Digging up 4'x4'of asphalt for a gas service replacement to 262 S Wagner <br />PM 31210163 <br />Work will commence on or about _~0~4~/0~1~/~2~0~1~6 for approximately 60 days. <br />I,the undersigned,certify that I am the owner of the respective property,or ani 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 />PtE R..D,~, <br />Signature of Applicant.Title <br />3 -7-:<016" <br />Date