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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 12/9/2020 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E _ PM 44134623 <br />(Applicant Name) <br />220 Channel St, Stockton, CA <br />(Mailing Address) <br />Stockton, CA, 95202 <br />(City, State, Zip Code) <br />925-701-1564 <br />(Area Code - Telephone Number) <br />gxjl@pge.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 />12/18/2020 TO 312021 DRIVEWAYS: <br />oc ec�tc <br />Lockeford QUAD NE <br />Bell Hole <br />SS/WW, R-29, Trench Cut Policy <br />pecla on -tions <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 North side of Locke Rd approximately 10' feet/mile west <br />of N Fillmore St Lockeford by performing the following work (description of work): <br />Pavinq repair post leak repair. <br />Work will commence on or after 12118 or upon approval for approximately 1 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 />�� QB2.GL/.csL <br />Signature of Applicant - Title <br />V]FORMS&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />Date <br />12/9/2020 <br />