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PLEASE PRINT: <br />APPLICATION FOR ENCROACHMENT PERMIT <br />Date 4/20/2022 <br />To: San Joaquin County <br />Department of Public Works <br />PGE <br />(Applicant Name) <br />3136 BOEING WAY <br />(Mailing Address) <br />STOCKTON, CA 95206 <br />(City, State, Zip Code) <br />209-687-5031 <br />(Area Code - Telephone Number) <br />jlzi@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 <br />REF # <br />CR # <br />TO 011512022 DRIVEWAYS: <br />Kenyon St. <br />Stockton QUAD <br />Bell Hole <br />SSMNV, R-29, Trench Cut Policy <br />Special Conditions <br />PM 45164508 -- D# LK 122919663 2930 KENYON ST STOCKTON <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the South side of Kenyon St approximately 160 feet/rr:ge East <br />of Myran Ave I Stockton , by performing the following work (description of work): <br />PGE to excavate 5x5 bellhole to repa r gas leak, cctyrhe/ oso t inspection may take place <br />Restoration to follow - APPX 3 DAYS OF WORK <br />Work will commence on or after 61619099 for approximately 120 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 />�.G� �Cel'YG62.Ce� <br />S'41ature of licant - Title <br />V]FORN6&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />4/20/2022 <br />Date <br />