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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 3/2/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 3 OD REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE -f��s <br /> PG&E VALID _ TO DRIVEWAYS: <br /> (Applicant Name) STREET Ara P,1 <br /> 4040 WEST LN AREA Al <br /> TYPE QUAD <br /> t�C' le- * <br /> (Mailing Address) FORMS S WA/ <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 42319383 <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 N ARATA RD approximately 1095' feet/mile NORTH <br /> of ARATA RD , STOCKTON by performing the following work(description of work): <br /> EXCAVATE (1)4'x4' BELLHOLE REPLACE GAS SERVICE TO 2891 N ARATA RD, STOCKTON. <br /> Work will commence on or about 3/16/2015 for approximately 15 days. <br /> I,the undersignW, 5iRify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work descr' ve in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> 3/2/2015 <br /> S' pp scant-Title & X w Z 6 P&0.C,�, Date <br /> E:PUB-SV.WKVvMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br />