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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To: San Joaquin County <br />JOB # REF # <br />Department of Public Works APN CR # <br />EXP. DATE <br />VALID TO <br />DRIVEWAYS: <br />STREET * <br />AREA QUAD <br />* <br />TYPE * <br />FORMS <br />NOTES <br />(City, State, Zip Code) <br />(Area Code - Telephone Number) <br />(Email Address) <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way o n <br />the ______________ side of ___________________________________ approximately ___________________ feet/mile _________ <br />of _______________________________________, ____________________, by performing the following work (description of work): <br />Work will commence on or after _____________________________________ for approximately ________________________ 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 />Signature of Applicant - Title Date <br />Y:\FORMS & TEMPLATES\ENCROACHMENT PERMIT APPLICATION.doc (08/08) <br />Sketch (Detailed plans may be submitted) <br />&UHZWRFDOO6-&RXQW\,QVSHFWRUDW  WRKRXUVEEHIRUHZRUNVWDUWV <br />:KHQFDOOLQJFUHZVKDOOUHTXHVWUDLQFOHDUDQFHIRUDQ\ZRUNGXULQJZLQWHUPRQWKV <br />1RYHPEHUUWKURXJKK0DUFK <br />3* ((300 <br /> "QQMJDBOU/BNF<br /> <br /> .BJMJOH"EESFTT<br /> <br />220 Channel St, Stockton, CA <br />Stockton, CA, 95202 <br />925-701-1564 <br />gxjl@pge.com <br />31531459 <br />12/10/2021 <br />NORTH 18' <br />BRUELLA RD <br />WEST <br />ACAMPO <br />E SOUTH ORCHARD RD <br />REG STATION/GAS MAIN PROJECT INSTALL/REPLACEMENT PROJECT. CCTV MAY TAKE PLACE <br />122/16/2022 <br />ROAD CLOSURE FOR TRENCHING DURING PROJECT CONSTRUCTION DATES 2/16/2022-3/2/2022 <br />STANDARD WORK HOURS 7AM - 5:30PM <br />12/10/2021