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.•-"...(--.1'"t I •.••\"":\'"\".-_,-."I 1;.,'-'~..-,.,, <br />OFFICE USE ONI.Y <br />JOB#73tJ(»L REF# <br />APN CR# <br />EXP.DATE 6 -/-/6 <br />VALID Of-/--(fJ TO 6-1-/(,DRIVEWAYS: <br />STREET &• <br />AREA • <br />TYPE • <br />FORMS <br />NOTES <br />."'.'.i \.i:.L' <br />APPLICATION FOR ENCROACHMENT PERMITS t,~:J _,\:.d i;"CC !)i.!T Y <br />2016 J~;';32 r~1~9:04 <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 />PLEASE PRINT: <br />Date 1/26/2016 <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 East side of S.Wagner Ave.'approximately 394'feel/mile North <br />of Horner Ave..Stockton ,byperformingthefollowingwork(descriptionofwork): <br />Excavate (ll4'X4'hellhole to replace existing gas service to <br />504 S.Wagner Ave.,Stockton. <br />PM 31210162 <br />Work will commence on or about __0_4~/_O_J_/_2~0_1~6 for approximately 60 days. <br />I,the undersigned,certify that I am the owner of the respective property,or am 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 />lfee.I2.t).-~ <br />Signature of Applicant-ntle <br />3-7-:<'olt <br />01/26/2016 <br />Date