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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 5/2'1/1(..OFFICE USE ONLY <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 />JOB# <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />f/llXJ'!iJ-l.P REF # <br />•CR#lof>!l~."'/'il(p 'TO /(),&i!fd'I1'!m.6 gD. <br />#1Wr«1'I QUAD rSG <br />?£u.Ili>14,S6,u <br />S;YUl~,it...2'l <br />DRIVEWAYS: <br />Sketch'(Detailed plans may be submitted) <br />"pM 30-3 ("5D I <br />Ivol-iF:1f16ol{;'Cfq <br />SEE ATTACHED SKETCH <br />I <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br />the ~side of C--As-l-l~[?of approximately '2<2 l.-~mile tV <br />of ~V j..IA <...----0<.12t>l ,M •.•.fI ft C4 ,by performing the following work (description of work): <br />r;;K Ci4u,4-N (t2.S-'{(C &11)lv ~A-trJD t3D"~urd'~y Ilu~w«,!' <br />13.(II Ho/~i~I tJ Oiv-/- <br />5"1 c}.-:>/Ib <br />Datepplrcant.Title <br />Work will commence on or about (0 I I 1 2-.:>((."for approximateiy I<j D days. <br />I,the undersigned,cert!!y)harlam the owner of the respective property,or am qualified to represent the owner and agree to do the <br />work described abov 1n accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />E:IPUB-SVWKtMASTERPS1ENCROACHMENT PERMIT APPLICATION.OOC [01Ioa)