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APPLICATION FOR ENCROACHMENT PERMIT <br />Date 12/27/21 <br />To: San Joaquin County <br />Department of Public Works <br />Candice Laccetti - Pacific Gas & Electric <br />(Applicant Name) <br />1524 N. Carpenter Rd <br />(Mailing Address) <br />Mocdesto, 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 35302282 <br />JOB # <br />APN <br />EXP. DATE <br />VALID1/19/2022 <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730052 REF # <br />CR # <br />TO 7/15/2022 DRIVEWAYS: <br />Los Angeles Ave. <br />Stockton QUAD WS <br />Trench <br />SS/WW, 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 East side of S Los Angeles Ave approximately 166 _ 0 feet/ Q mile North <br />of W. Washington St Stockton , by performing the following work (description of work): <br />Traffic control for PG&E to trench and install new gas service. Restoration to follow as needed. <br />Work will commence on or after 1/19/22 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 />12/27/21 <br />Signature of Applicant - Title <br />Date <br />