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APPIICATIONFOR ENCROACHMENrPERMIT <br />PLEASE PRINT: <br />Date !/'7/J". <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 />Sketch (Detailed plans may be submitted) <br />OFFICE USE ONLY <br />JOB#7300£~REF# <br />APN CR# <br />EXP.DATE W-?HG <br />VALID 'l+9-{{,TO fO-Y-//"DRIVEWAYS: <br />STREET 2+&~'f'1 if;Z)9r t.Z.~• <br />AREA 'j1oct-lon QUAD ?£• <br />TYPE 8~r"• <br />FORMS >~W'I1/6222 <br />NOTES <br />SEE ATTACHED SKETCH <br />The undersigned hereby applies for permission to exc ate,construct and/or otherwise encroach on County Highway Right-ot-Way on <br />the UJ6sr side of s://wY :RtWrA approximateiy 350 feeUlliRe ~:z7/ <br />of -,.,by performing the following work (description of work):.?ro 3 S,#HlY tl9 UMlr/l-6Cf#A V47£~'K!/'me t2Y{£t:")lt4IfA;77(M/7P ~~w£N <br />Work will commence on or about for approximateiy o 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 />ItiLtL~d -Signature of Applicant -Title <br />E:\i'Ua-sV.WKlMASTERPSlENCROACHMENT PERMIT Al'I'UUTION.DOC [D1J1lB) <br />&/tS bu//!%'£ <br />JG,o./5.