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C;�s L- <br /> Zog-g�Z-l`�Z-t <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 4/28/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# �� REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE G-I- <br /> PG&E VALID - - TO `- -2pr� DRIVEWAYS: <br /> (Applicant Name) STREET <br /> 4040 WEST LN AREA �C�UAD C� <br /> TYPE + �-o <br /> (Mailing Address) FORMS <br /> STOCKTON, CA 95204 NOTES <br /> (City,State,Zip Code) <br /> 209-942-1421 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> SEE ATTACHED SKETCH <br /> PM#: 42363758 <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 Marine Ave approximately feet/mile <br /> of between LaJolla Ave&Alpine Ave Stockton , by performing the following work(description of work): <br /> Pot hole various locations in response to San Joaquin County's East Country Club Phase II street reconstruction project. <br /> San Joaquin County proiect contact: Stephanie Kong <br /> Work will commence on or about 5/4/2015 for approximately 14 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 abov in accord nce with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> 4/28/2015 <br /> rg ature of Applicant-Title Date <br /> E:IPUB-SV.WKWASTER.PSIENCROACHMENTPERMITAPPLICATION.DOC (OV08) <br />