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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 210312020 <br />Το : San Joaqu in County <br />Department of Public Works <br />PGE ΡΜ 31472262 <br />(Applicant Name) <br />3 136 Boeing Way <br />(Mailing Address) <br />Stockton, CA 95206 <br />(City, State, Zip Code) <br />(209) 21 0-0454 <br />(Area Code -Telephone Number) <br />T8M 3@PGE.COM <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />OFFICE USE ONL Υ <br />JOB# 'Εω5-;J-(_ο_ REF# <br />ΑΡΝ CR# <br />EXP.DATE <br />VALID <br />STREET <br />AREA "t>I QUAD /ι/Ε. <br />ΤΥΡΕ /4ttZ./jq L ~ <br />FORMS ~ww <br />NOTES , , -S~Q J.:ι L <br />Crew to call SJ County lnspector 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 />t>o lt' ιλ(ψ (t)χ, 3 ς..,... ~,..OrA <br />c-d1~ ()~ ςz_δ · <br />DRIVEWAYS : <br />The undersigned hereby appl ies for permission to excavate , construct and/or otherwise encroach on County Highway Right-of-Way on <br />the Nor1h side of Ε Ke ttlem an Ln appro ximately 335 feeUmile _w_es_t __ <br />of Ν Alp ine Rd Sto ckton , by performing the following work (description of work): <br />Gen e ral Overhe ad Pole Mainte nance <br />Work will commence on or after _61_1_212_0_20 ___________ for appro ximately _1 ________ days. <br />1, the undersigned, certify that I am the owner of the respective property, or am qualified to represent the owner and agree to do th e <br />work descri bed above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />1:Jιv. Mart/Helι 02 /03/2020 <br />Signature of Applicant • Title Date <br />Y:IFORMS & TEMPLATESIENCROACHMENT PERMIT APPLICATION.doc (08/08)