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APPLICATION FOR ENCROACHMENT PERMIT <br />OFFICE USE ONLY <br />, <br />JOB#18o()5')...{p ."'-REr#------ <br />APN BI'lIfo <br />CR# <br />EXP.DATE <br />VALID 4-/25"/1&TO B "It",DRIVEWAYS: <br />STREET 'I)}ItlG 11#.I'• <br />AREA ~/4'oNQUAD 65 • <br />TYPE '1!56t£.-I/b'-6,p6 .• <br />FORMS <br />NOTES <br />-¥V~kZ9$Md /!VII/;.'If1 <br />PLEASE PRINT: <br />To'-"SanJoaqQinCounfy' <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 />Date ;l.,2:{-/t:, <br />Sketch (Detailed plans may be submitted) <br />.PlY!.3122/388 <br />SEE ATTACHED SKETCH <br />The undersigned hereby applies tor permission to excavate,construct and/or otherwise encroach on County Highway Right-of.Way on <br />the £IIsr side of .5.DLIUe ALIE •approximately 'I9D feet/llliIe NDlZn/ <br />of HOlbJ£t<I9ve ,~@ C1(/1)1.1 •by performing the following work (description of work): <br />SUi.s.OLiVe /''It/e. <br />£.x C>4.t./A.TIE:If'.",'"NOUS:Duell."-AS M~/A.f AAiiJ.&J!2E J:r~7ZJ.IAI.!:rALL IJIE:/;oJ 6//S.S.£~U1t:e'.E.x.t::AI.lAnoA/Jt)Be ,z;u PI'IVcz::, <br />A/Ze'I'I.I"I!£/ZMIAlJ"lA//ASPl-Il1Lt /Ciff'PLACI£'IYICA./r 7tJ rOLLOW. <br />Work will commence on or about 9-25'-11:.for approximateiy 90 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 />(},)4~;Vtl"Signature of Applicant -Title <br />.2-2.£}-/t:, <br />Date <br />E:IPUB-SV.WKlMASTERPSlENCROACHMENT PERMIT APPUCATlON,OOC ((l1/lla)