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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 4/13/2022 <br />To: San Joaquin County <br />Department of Public Works <br />PGE <br />(Applicant Name) <br />3136 BOEING WAY <br />(Mailing Address) <br />STOCKTON, CA 95206 <br />(City, State, Zip Code) <br />209-687-5031 <br />(Area Code - Telephone Number) <br />j1zi@pge.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730052 REF # <br />CR # <br />5f f2022 TO DRIVEWAYS: <br />Oiange Ave. <br />Escalon QUAD <br />–S–eff TroTe— <br />6�VVVV, K-29, I rench uuto¢y <br />Special Conditions <br />PM 45168759 -- DARK 122950528 29065 E ORANGE AV ESCALON <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the _ SOUTH _ side of E ORANGE AVE -------approximately _550 _ _ _ feef/mNe _WEST <br />of _ SEIDNERRD — — — _,– ESCALON _ by performing the following work(description of work): <br />PGE to excavate 44 bellhole to repair gas leakcctypre/post inspection may take place <br />Restoration to follow - APPX 3 DAYS OF WORK <br />Work will commence on or after_ — l022 — — — — — — _ for approximately_ — 3 — — — _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 />C� 2�� <br />S' ature of licant -Title <br />urovus areurovESENEROACHM r PERM APPL-1Off P.e mage, <br />4113/2022 <br />Date <br />