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44680618 <br />APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 11/24/2021 <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 <br />Code) 209-355-5087 <br />(Area Code - Telephone Number) <br />CYSO@PGE.com <br />(Email Address) <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 />12/22/2021 TO 6/1/2022 DRIVEWAYS: <br />Horner Ave. w <br />Stockton QUAD ES w <br />Bell Hole w <br />SSAMI R-29, Trench Cut Policy <br />Special Conditions <br />Sketch (Detailed plans may be submitted) , <br />N <br />See attached <br />i <br />^�' 1 <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 Horner Ave _approximately 20' fccymile_Wnst <br />Of q Orn _, _ by performing the following work (description of work): <br />Restoration to be completed 6'X2' @ 5" <br />Work will commence on or after - 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 />.,Touts,TWPaTESEN�wHWWPEWIT APPLI eTioNd,,(OMe) <br />11/24/2021 <br />Date <br />