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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> 5/7/2015 <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 :3 05-Z REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 15 <br /> PG&E VALID 5-2 7-1$ TODRIVEWAYS: <br /> (Applicant Name) STREET 7-+0 S t <br /> 4040 WEST LN ARE +, 1 A QUAD 5TYPE S <br /> �l <br /> (Mailing Address) FORMS ,S,S Liz 1,1z 1 q <br /> STOCKTON, CA 95204 NOTES <br /> (City,State,Zip Code) <br /> 408-316-1767 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> SEE ATTACHED SKETCH <br /> PM 31151206 <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 7th St approximately 140' feet/mile east <br /> of S Laurel St Stockton , by performing the following work(description of work): <br /> Excavate 1 4'x4' bellhole and trench 40'to install new e deep well anodes stem. <br /> Work will commence on or about— for approximately 30 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 desc*d above in accor(fance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> . gnature of Applicant-Title Date <br /> E:IPUD-W.WKUASTER.PSIENCRORCHMENi PERMIT APPLICATION.DOC (01108) <br />