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, 1 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date A OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE !�-(S'1 <br /> PG&E VALID ' �^ TO DRIVEWAYS: <br /> (Applicant Name) STREET Cti&Qge-e <br /> 4040 WEST LN AREA -L.OH QUAD <br /> TYPE <br /> (Mailing Address) FORMS 4s w zfJ <br /> STOCKTON, CA 95204 NOTES <br /> (City, State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> SEE ATTACHED SKETCH <br /> X10 $Z is'+g D w a AND T<.P <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County HighPee <br /> Right-of-Way on <br /> the EAS r side of CiRf-W4IC" 2.D. approximately L ile SOUSof 50 tss9:j AVf by performing the following work( ription of work): <br /> 105TAL.V AtST0. ISot-ynoN VArWa oW Low-PeessumF Gx& SYSTF^g <br /> Work will commence on or about 1 for approximately S 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 descri ve in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> PtrmiI � ;"C4V o /�9 //5- <br /> a p scant-Title Date <br /> E�PUB-SV WKIMASTER PSIENCROACHMEFIr PERMIT APPLICATION DOC (01/08) <br /> �2kw16 pvc . 6-0M <br />