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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 7/8/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> PG&E EXP. DATE N ZQf<� <br /> VALID — TO DRIVEWAYS: <br /> (Applicant Name) STREET L. <br /> 4040 WEST LN AREA QUAD ` <br /> TYPE <br /> (Mailing Address) NFORMS <br /> OTES <br /> STOCKTON, CA 95204 <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 31160937 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the SOUTH side of E WATTERS RD approximately 845' feet/mile EAST <br /> of S MCKINELY AVE , FRENCH CAMP , by performing the following work(description of work): <br /> EXCAVATE(1)4'x4' BELLHOLE TO REPLACE GAS SERVICE TO 423 E WATTERS RD <br /> Work will commence on or about 8/1/2015 for approximately 30 days. <br /> I,the undersigned,certify that I am t e-owner-o the respective property, or am qualified to represent the owner and agree to do the <br /> work described above in accord nce with the rWes�nd regulations of San Joaquin County and subject to inspection and approval, <br /> 7/8/2015 <br /> Signature of Applica - e Date <br /> E:IPUB-SV.WKIMASTER.PSIENCROACHMENTPERMRAPPLICATION.DOC (01108) <br />