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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 9/1/21 <br />To: San Joaquin County <br />Department of Public Works <br />PGE PM 35204453 <br />(Applicant Name) <br />3136 Boeing Way <br />(Mailing Address) <br />Stockton, CA 95206 <br />(City, State, Zip Code) <br />209-279-3846 <br />(Area Code - Telephone Number) <br />S9P3@PGE.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 />730052 REF # <br />CR # <br />10/15/2021 TO 12/1/2021 DRIVEWAYS: <br />Cakwilde Ave. <br />Stockton QUAD M <br />Box Replacement, Install Electrical SeNicces <br />SSWVV, R-29 <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 side of approximately feet/mile <br />of , by performing the following work (description of work): <br />Revision to Permit # PS -2101367 <br />PGE to install new electric service in customer installed conduit. PGE to abandon existing direct buried service. PGE to remove #1 <br />box, customer to install #2 box at location <br />Work will commence on or after 10/15/2021 for approximately 5 <br />days. I, the undersigned, certify that I am the owner of the respective property, or am qualified to represent the owner and agree to <br />do the work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and <br />approval. <br />staGS ?0l1G2 <br />Signature of Applicant - Title <br />V]FORMS&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />9/1/2021 <br />Date <br />