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PLEASE PRINT: <br />Date 928/22 <br />To: San Joaquin County <br />Department of Public Works <br />Impenal Underground Development <br />(Applicant Name) <br />1761 Lopes Ave <br />(Mailing Address) <br />Merced Ca, 95341 <br />APPLICATION FOR ENCROACHMENT PERMIT <br />(City, State, Zip Code) <br />(209) 658-7819 <br />(Area Code - Telephone Number) <br />lomeli.jimmy9@gmail.com <br />(Email Address) <br />may <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />110005 REF # <br />CR # <br />10/10/2022 TO 11/15/2022 DRIVEWAYS: <br />Piccoli Rd. <br />Stockton QUAD NS <br />Trenching <br />SSMNV, R-29, Trench Cut Policy <br />Special Conditions <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the t <br />side of approximately 100 @ feet/ @mile <br />of Asphalt Dirt by performing the following work (description of work): <br />Trench For PGE Electric <br />Work will commence on or after 10/10/2022 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 />�I712YJt7y .C'bnZc`'.C'9 <br />ignaure Or pp ican - I me <br />9/29/22 <br />Date <br />