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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />To:San Joaquin County <br />Department of Public Works <br />PG&E <br />(Applicant Name) <br />4040 WEST IN <br />(Mailing Address) <br />STOCKTON,CA 95204 <br />(City.State.Zip Code) <br />408-316-1767 <br />(Area Code -Telephone Number) <br />-.'\..,.•.'..".OFFICE USE ONlY'-.. <br />JOB#?5IlOS2.-REF# <br />APN CR# <br />EXP.DATE !<-Ir-!{;VALID $-r-l~TO £'--/£-/£DRIVEWAYS: <br />STREET @ifOY1 • <br />AREA .1?~jf)&o QUAD Al6 • <br />TYPE • <br />FORMS C;(WW f2?f/NOTES , <br />J.j-/-/hDate <br />Sketch (Detailed plans may be submitted) <br />?/J'J 3/2~BL//t-j <br />SEE ATTACHED SKETCH <br />37-0'1 L l3J<IICl2olJ 120.. <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br />the SOurH side of I3IiRROIJ ,eD,approximately 95"5 feet/rlIIi!e W=S7' <br />of HUJY '1'1 FRoNTAGe:Rb.,SC.riMI'D ,by performing the following work (description of work): <br />£xCI'lt//1,E '/'Y-'I'Hou::ou6/?rHe £.J'lS h1AI.(//1I./ZJ cur Orr SCRVIC£. <br />P&h1/1I'J£AI7'/1$PII.I1LI RePLI1~n1£1J1 TD roLLOuJ. <br />Work will commence on or about 5-'1-/6 for approximately 'to 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 />~ork described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />-CAS /I,i).€.'i-i-It:. <br />Date