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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date ..3 -B -Ih <br />To:San Joaquin County <br />Department of Public Works <br />PG&E <br />(Applicant Name) <br />4040 WEST LN <br />(Mailing Address) <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 />Pm 3121£0233 <br />NOTfF //11;;5"172 <br />OFFICE USE ONLY <br />JOB#~A -J.(,:,REF#/:;X'o;)- <br />APN CR# <br />EXP,DATE e(15111.o <br />VALID '5-;)'.I(P TO Bks/JIP DRIVEWAYS: <br />STREET A (W10 rd uJ:>od f!d., <br />AREA 1110.f'fe.c.a.QUAD Sw , <br />TYPE -r:J(l-io Ie.'' <br />FORMS <br />NOTES <br />;;/hW){Z-Z-5,fl-et1d,M-l6l>c1 <br />SEE ATTACHED SKETCH <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br />the MoR.n-/-side of IILfYlotJl:iL..Jooi:::.R..ll.approximately &;35'feet/lllIi!e eAST <br />of OLb'7lJlJ£/2 Ave:..,/YlN.ur£CA ,by performing the following work (description of work): <br />Ex CIllUIlr'c "I'J'-'f I /-fOLe OUeR.c,,1II..s.MAlA.!1'IA.1b..I/If$.TJ4LL Net..) <br />[;fIs.S£R.L/Ic£.?Eh1/lJlwl/re /'IS?flALT 12EPLnt:.EI-ntSL/r TO ,cbLLOtJ <br />Work will commence on or about for approximately 9D 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 above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />s-B-ILt, <br />Date <br />E;\I'U8-SV.WKlMASTERPSlENCROAGHMENT PERMIT APPLICATION DOC (01100)