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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 9/23/2013 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7. 0652= REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE �� 3 <br /> PG&E VALID LOIvaTO 3 DRIVEWAYS: <br /> (Applicant Name) STREET UD6LFzE Rb. <br /> AREA t'%tt .QUAD <br /> 4040 WEST LN TYPE 13C-LL Nott <br /> (Mailing Address) FORMS 55 ww -2 rtAtk its pa <br /> NOTES <br /> STOCKTON, CA 95204 <br /> (City,State,Zip Code) <br /> 209-942-1421 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> SEE ATTACHED <br /> PM 31023393 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the WEST sideof S WOLFE RD approximately 592 ' feet/mile NORTH <br /> Of. BOWMAN RD FEENCH CAMP by performing the following work(description of work): <br /> EXCAVATE (1 ) 5 'X5 ' F3 T T HOT F TO PtIN NEW GAS S RVTCF TO 9635 WOT RD <br /> Work will commence on or about 10/1/2 013 for approximately -�o 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 /> /111 -i�? 4L- 3 <br /> ature of Applicant-Title Date <br /> E,IPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />