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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 6/3/2020 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35178536 <br />(Applicant Name) <br />6121 Bollinger Canyon rd <br />(Mailing Address) <br />San Ramon, CA 94583 <br />(City, State, Zip Code) <br />925) 270.6009 <br />(Area Code - Telephone Number) <br />d6d3(cDpge.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730052-10 REF # <br />CR # <br />7/15/2020 <br />6/11/2020 TO 7/15/2020 DRIVEWAYS: <br />MORRISON AVE <br />STOCKTON QUAD NS <br />TRENCHING <br />SSNNN, R-29, TRENCH CUT POLICY <br />SPECIAL CONDITIONS <br />Crew to call SJ County Inspector at (209) 953-7421 48 to 72 hours before work starts. <br />When calling, crew shall request "rain clearance" for any work during winter months <br />November through March <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway t -of -Way on <br />the North side of John Street approximately 134 fee ile south <br />of N Morrison Ave Stockton , by performing the following work (descrip Ion of work): <br />PGE is to Trench & Install 39' of 1-1/4" Plastic Low Pressure Service (Distribution Pressure) <br />Work will commence on or after 6/10/2020- 6/28/2020 for approximately 14 days 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 />Y]FORN6&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />6/3/2020 <br />Date <br />