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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 3/9/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 72007Z REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE h-15'—1 S <br /> PG&E VALID 4-14-15 TO 6-1S- DRIVEWAYS: <br /> (Applicant Name) STREET <br /> 4040 WEST LN AREA QUAD <br /> TYPE <br /> ren <br /> (Mailing Address) FORMS �S /ta/ ZG! <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 /> PM 31084263 <br /> The undersigned hereby applies for permission to excavate,construct and�or otherwise encroach on County Highway Right-of-Way on <br /> the side of ACADEMY ST approximately 60' feet/mile EAST <br /> of ORANGE ST , WOODBRIDGE _, by performing the following work(description of work): <br /> EXCAVATE 45'ACROSS ACADEMY ST, WOODBRIDGE. <br /> Work will commence on or about 5/1/2015 for approximately 60 days. <br /> I,the undersigns ify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work descr' a in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> fvr M.; 4- 4✓ 3/9/2015 <br /> ignature of Applicant-Title /� P6E Caw Date <br /> E:IPU&SV.WgMASTER.PSIENCROACHMEM PERMIT APPLICATION.DOC (01108) CJ C <br />