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PM 35190799 <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 />Princeton Ave. <br />Stockton QUAD CC <br />Bell Hole <br />SSNW ,, 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 South side of E Princeton Ave approximately 155' -(EDmile East <br />of Delano Ave. by performing the following work (description of work): <br />Paving Job location approx 155' <br />East of Delano Ave on the south <br />side of Princeton Ave. Approx <br />from ROW, approx 8' CL and <br />approx 6" EC. 6'X6' <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 />C 151a&a-d- <br />Signature of Applicant - Title <br />V]FORN6&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />12/23/21 <br />Date <br />