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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 8/26/2020 <br />To: San Joaquin County <br />Department of Public Works <br />M_ <br />(Applicant Name) <br />3136 Boeing Way <br />(Mailing Address) <br />Stockton, CA 95204 <br />(City, State, Zip Code) <br />209-279-3846 <br />(Area Code - Telephone Number) <br />s9p3(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 />730052-6 REF # <br />CR # <br />11/1/2020 <br />9/2/2020 TO DRIVEWAYS: <br />Ashley Ln <br />Stockton QUAD M <br />Trench <br />SSMNV, 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 Right -of -Way on <br />the side of E Ashley Ln approximately 570 EDmile East <br />of --Ee7and Way by performing the following work (description of work): <br />PM- 35157531 <br />Install new gas service. PGE to perform all excavation. <br />Work will commence on or after 9/1/2020 for approximately 10 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 />P� 8/26/2020 <br />Signature of A plicant - Title Date <br />V]FORN6&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />