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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 02/03/2016 <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 />OFFICE USE ONLY <br />JOB#7"7(2052-REF# <br />APN CR# <br />EXP.DATE {,-I -/6 <br />VALID t+(b TO 6+/&DRIVEWAYS: <br />STREET ~Av • <br />AREA 510cfiM QUAD £5 • <br />TYPE ~&/l)q <br />• <br />FORMS JX:rnch <br />NOTES <br />Sketch (Detailed plans may be submitted) <br />SEE ATTACHED SKETCH <br />approximately 307'feeUmile West <br />,by performing the following work (description of work): <br />existing gas service to <br />Stockton <br />to replace <br />the South side of Dana Avenue <br />of N.Cardinal Avenue <br />Excavate (1)4'X4'be11ho1e <br />5334 Dana Avenue,.Stockton. <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br />PM 31209922 <br />Work will commence on or about 04/0112016 for approximately 60 days. <br />I,th~igned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the"'".i~.OO?wl'h'",o'~'M"!l0'''''''.S;"J""l0'"Coom"Mrobi'.to,_"""~d'pp~' <br />______~__------------02/03/2016 <br />Signature of Applicant -Title Date