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PM 44681360 <br />APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 12/23/21 <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 />209-355-5087 <br />(Area Code - Telephone Number) <br />CYSO@PGE.com <br />(Email Address) <br />may <br />See attached <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 />12/29/2021 TO 7/1/2022 DRIVEWAYS: <br />Anteros Ave. <br />Stockton QUAD ES <br />Bell Holes (2) <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 Higl-wa Right -of -Way on <br />the East side of Anterns Ave approximately 235'-245'ee <br />alf ile North <br />of by performing the following work (description of work): <br />PGE to complete restorations: Paving location is approx 235' north of E Paving location is approx 245' north of E Main <br />Main St on the East side of Anteros on the East Side of Anteros Ave. This is <br />Ave approx 3' FP and approx 8' ROW approx 3' from EP and approx 8' ROW. <br />approx 3' Cl R'XR' @ 4 1 "-8" deep approx 6" from CL. 10'X8' lad 6" deep. <br />Work will commence on or after 12/29/21-07/01/2022 for approximately 2 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 <br />V]FORN6&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />12/23/21 <br />Date <br />