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PLEASE PRINT: <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 />Date Z/Ol)II~.-- <br />J OFFICE USE ONLY <br />J08#7Jo051-REF# <br />APN CR# <br />EXP.DATE 9-f)-/6 <br />VALID ?-7-({.,TO 9-(5 -I G DRIVEWAYS: <br />STREET Arm $trwg ~.• <br />AREA •W'U tVWTYPE(Splb,If Ie • <br />FORMS SSWWAlq <br />NOTES <br />Sketch (Detailed plans may be submitted) <br />:P.AA '.3 IZ-llf7 dc( <br />SEE ATTACHED SKETCH <br />/L/;IiF:1/1/0 $2 3g <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right.of-Way on <br />the .$D<A.-ft-side of W.Ail.NlST(2o":>bt {Z D .approximately /o3r UBiliimile e,4S~ <br />of lV.p.4V"!>lZ D.,,by performing the following work (description of work): <br />fClCr.•••v~(,)~.el /101.,itJ Di(2+AIJO E7YlF ••IIJDF/2 w.A(Z#rS7roN6r /(,ot'. <br />-CD tl'otljdoQ ,ww G14-s S-e,vt?e .,to /1'17 w.~/L.#1Tl'-o"v6r ll-i>. <br />Work will commence on or about _~3~7_'i-,-,-/~/~{,,~for approximately 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.-J->m ~-S/./l45 E1/''4I4~/2 <br />Sign ture of Applicant -Title <br />Dc../OS/20/6 <br />Date