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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT:2D16 Ftf)24 Pro 2:'2 <br />Date <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 />OFFICE USE-ONL),. <br />JOB #13()()5J.--<.e:,.REF# <br />APN •I CR# <br />EXP.DATE tll/it;;__ <br />VAliD ~~~'TO 7/'UWSTREETmy',0.£,e/).•j <br />AREA t,pPI QUAD ~It,} <br />TYPE ~,t.~OL.e <br />FORMS ~p £..';1 <br />NOTES <br />DRIVEWAYS:- <br />Sketch (Detailed plans may be submitted) <br />PM 312/9!3M3 <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 .souOt side of TJ1YLoR.Rll,approximateiy J;/.5 feetlrmle WC:$,T <br />of &.JE,SrC;I'!T£OR.La!:'l ,by performing the following work (description of work): <br />30k TA'-ILof2 /2~,House:to BE i:1t::1rlQLls;le2:>. <br />E)(L:.J1uIJ-eLi dOLl ou£/Z ,;';J9$I21l'/1tJ FWD CuT orE s£RVlc6 <br />EXCAt./lirtOL/TO DccuR ItJ AilCC 1'1I?&I9 , <br />Work will commence on or about 3-28-/6 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 />OQk :If~~-[,f.JS 41:::,,£ <br />tJ"Signature of Applicant -Title <br />E.1?IIIl-SV.WK\Mo\STER.PS\EHCROACHMENT PERIoITAPPl.ICAnoN,OOC (Ol,w) <br />2.2.'-1-/':' <br />Date