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APPLICATION FOR ENCROACHMENrPERMIT r','/''{v .~p <br />PLEASE PRINT: <br />Date OS/27/2016 <br />To:San Joaquin County <br />Department of PubiicWorks <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 />Sketch (Detailed plans may be submitted) <br />p/'fl312A 1902. <br />~..,. <br />OFFICEUSEONLY <br />JOB#1~J-G,.REF# <br />APN CR#. <br />EXP,DATE 1/;/tp , <br />VALID 7 b/14>f TO '7Mite DRIVEWAYS: <br />STREET jhlVtx-77J .•./AYe,r.• <br />AREA ffJClCrr",,j QUAD {!L . <br />TYPE UtL-lIoi!£• <br />FORMS :$'~~I l-~"1?~;ldZW$dc7 <br />NOTES <br />SEE ATTACHED SKETCH <br />!-",,"~__subject ,to pavement cuts shall receive on(1)-inch asphalt concrete overlay from the centerline (or Laneline)to the edeg of t~e trovel way as per the San JoaquinC.ounty Trench Cut Poltcy.If the pavement is disturbed on bothSidesofthecenterline(or adjacent lone),,then the entireroadway.(or affected lanes)shall be resurfaced.Contractor <br />sholl grmd.and overlay within 10 working doys of permanent Itrenchpavl~g,Shoulder arE!QS shall be brought up to finishgradeasdirectedbytheCounty. <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br />the NORTH side of PRINCETON AVE approximately 298'feet/mile EAST <br />of MARINE AVE STOCKTON ,by performing the following work (description of work): <br />EXCAVATE(1)4'x4'BELLHOLE TO REPLACE SERVICE TO 2047 PRINCETON AVE <br />PM:31241802 <br />Work will commence on or abou JULY)!,2016 for approximately 60 days. <br />a ure of Applicant -Title <br />I,the undersigned,ce9~ <br />work described711S in <br />that i e owner of the respective property,or am qualified to represent the owner and agreeto do the <br />rdance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />C,!Jj/c., <br />,Date <br />e:\l'UB-SV.WKlMASTERPS\,ENCROACHMENT PERMITP,PPUCATION.DOC (Ol~a)