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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 9/24/2020 <br />To: San Joaquin County <br />Department of Public Works <br />PGE -PM 35192711 <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 />730052-6 REF # <br />CR # <br />2/1/2021 <br />10/1/2020 TO 2/1/2021 DRIVEWAYS: <br />Oro Ave. <br />Stockton QUAD ES <br />Bell Hole <br />SSANVV, R-29, Trench Cut Policy <br />Special Conditions <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Right -of -Way on <br />the East side of Oro approximately 350 V9 mile South <br />of Horner by performing the following work (description of work): <br />PGE o excavate x4' bellhole to install new gas service and execute hot tie in. <br />Work will commence on or after for approximately bdays. <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 />�tCGC.c� �BrLC.� <br />Signature of P#plicant - Title <br />V]FORMS&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />9/24/2020 <br />Date <br />