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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 6/15/2020 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35177832 <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 />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP.DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <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 ermission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the East side of � Golden Gate Ave approximately 700 feet/mile <br />of 3525 Section Ave Stockton , by performing the following work (description of work): <br />PGE to do all Work. Cut off existing 3/4' Steel high Pressure Service at 2' Steel high pressure Main. <br />Work will commence on or after 7/13/2020 for approximately 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 />D� z2a& 14� 6/1512020 <br />Signature of Applicant - Title <br />V]FORMS&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />Date <br />