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APPLICATION FOR ENCROACHMENT PERMIT <br />Pm 311'iIB'!JI <br />,,...~,.,:.'':';.)S;\;~';0,~UI ..':.LC'\:;:H.JTY i <br />PLEASE PRINT: <br />Date <br />L.t_~.'(.~_:r .?UDL;.,;h'()~.J~S <br />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 />.. <br />DRIVEWAYS: <br />Sketch (Detailed plans may be submitted) <br />SEE ATTACHED SKETCH <br />The undersigned hereby applies for permission to excavate,construct and/or otherNise encroach on County Highway Right-ai-Way on <br />the £IIS'"side of PIA/USeD R[)approximately Ill'?£.feeVR A/oIZlY <br />of H£..)Y 1&.,..s.roc.K.TlJy,,by performing the following work (description of work): <br />25"2"7 P/AlI1-S:£o R1L <br />Ex Cdl/l1re <f'~<I'/fOLIE OUaz.Q115 m~/.A.1 AAilJ Cur DEI".sal/It:£. <br />EJ<LJ1vlfr/DAI TD o,ccuJ2e U/£J,Rr AI2£.Jq. <br />Work wili commence on or about for approximately 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 />,{,-7-It:. <br />Date <br />E:IPUIl-SV.WKlMASTER.PS1ENCROACHMENT PERMrT APPUCATION,DOC (01108)