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APPLICATION FOR ENCROACHMENT PERMIT <br />Date 3/31/22 <br />To: San Joaquin County <br />Department of Public Works <br />Pacific Gas & Electric - Candice Laccetti <br />(Applicant Name) <br />1524 N. Carpenter Rd <br />(Mailing Address) <br />Modesto, CA 95351 <br />(City, State, Zip Code) <br />(925) 303-9471 <br />(Area Code - Telephone Number) <br />C6L5@pge.com / STDivpgepermits@pge.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />PM 44626905 <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 Elvin Ave approximately 50 Q feet/ Q mile East <br />of Anthony Ave Stockton , by performing the following work (description of work): <br />Traffic control to excavate 5x5 bell hole to bore and shorten service. Restoration to follow. <br />Work will commence on or after 4/28/22 for approximately 180 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 />1� <br />Signature of Applicant - Title <br />3/31/22 <br />Date <br />OFFICE USE ONLY <br />730052 <br />JOB # <br />REF # <br />APN <br />CR # <br />EXP. DATE <br />VALID <br />4i2W282,22 111112022 <br />TO DRIVEWAYS: <br />STREET <br />vin Ave -. <br />AREA <br />Stockton QUAD E <br />TYPE <br />Bell Hole, Bore <br />FORMSbb/VVVV,H-29, <br />1 rencn Uuto icy <br />NOTES <br />bpecial Uonditions <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 Elvin Ave approximately 50 Q feet/ Q mile East <br />of Anthony Ave Stockton , by performing the following work (description of work): <br />Traffic control to excavate 5x5 bell hole to bore and shorten service. Restoration to follow. <br />Work will commence on or after 4/28/22 for approximately 180 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 />1� <br />Signature of Applicant - Title <br />3/31/22 <br />Date <br />