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., <br />APPLICATION FOR ENCROACHMENT PERMIT 2fi'"-r~"1 <:".7'I 2,0 t tb ~'4 I;:.•... <br />PLEASE PRINT: <br />Date JAN 28,2016 OFFICEUSEONLY <br />To:San Joaquin County <br />Departmentof 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 />JOB#1!uJ"iJ-'&'REF# <br />APN CR# <br />~~~i~ATE -.{-JI-!i-~-~~j;~~~~(,-M;lit- <br />STREET ?:tJAI/.I'f'eo.h <br />AREA ~,<./QUAD ?f:. <br />TYPE &-j/#;/i.'5&J i ?Jjj-/.~en~~;:-,-- <br />FORMS <br />NOTES <br />DRIVEWAYS: <br />Sketch (Detailed plansmay be submitted) <br />SEE ATTACHED SKETCH <br />The undersigned hereby applies for permission to excavate,construct andlor otherwise encroach on County Highway Right-of-Way ontheNORTHsideofSUNNYRDapproximately1027'feeVmile EAST <br />of S.CA 99 KINGSLEY RD ,STOCKTON,by performing the following work (description of work): <br />EXCAVATE (2)4'X4'BELLHOLES AND (1)7'TRENCH TO REPLACE GAS SERVICE TO 3565 SUNNY RD. <br />PM 31210169 <br />days.60forapproximately <br />JAN 28,2016 <br />Date <br />20Workwillcommenceonorabout <br />I,the undersigned,C .Ythat I am the ow the respective property,or am qualified to represent the owner and agreeto do the <br />Ith the rules and regulations of San Joaquin County and subject to inspection and approval. <br />E-v>Uil-SVWKWASTE~PS\EHCROACHIlENT PERMIT APPLICATION DOC (ll11Oa)