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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 9/19/22 <br />To: San Joaquin County <br />Department of Public Works <br />Pacific Gas & Electric- Candice Laccetri <br />(Applicant Name) <br />1524 N. Carpenter Rd <br />(Mailing Address) <br />Modesto, CA 95351 <br />(City, State, Zip Code) <br />(925) 303 9471 <br />(Area Code - Telephone Number) <br />C6L5@pge. com / STDivpgepennits(cl corn <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />PM 35335168 <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPErai–lemic <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730052 REF # <br />CR # <br />10/01/2023 TO DRIVEWAYS: <br />ewvca a Rd. <br />Stockton QUAD SE <br />Coi l Devices <br />SSNWV <br />Special Conditions <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the Both side of Newcastle Rd approximately 864 Qfeet/ Omile soem <br />of _ Arch Rd _ _ _ _ _, _ _ srodaon J by performing the following work (description of work): <br />Traffic control to tie in new gas service. (ALL WORK IS WITHIN THE CITY OF STOCKTON) <br />Work will commence on or after_ — — — 2/e/23 _ _ _ _ for approximately_ _180_ _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 />9/1922 <br />Signature of Applicant - Title <br />Date <br />