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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3 <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 />(408) 316-1767 <br />(Area Code - Telephone Number) <br />STDivPGEPennits@pge.com <br />(Email A cess) <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 REF# <br />CR # <br />7/1/2023 TO 1/1/2024 DRIVEWAYS: <br />Kasson Rd. ' <br />Tracy QUAD SW <br />Aerial Work <br />SS/WW <br />Sketch (Detailed plans may be submitted) <br />x <br />G. 2z4' <br />The undersigned hereby t <br />the side <br />Of <br />excavate, construct andlor otherwise encroach on County highway right-of-way on <br />approximately 24:1 fO feettQmile 5 <br />=E4 , by performing the following work (description of work): <br />Work will commence on or after 1—(-2 7 for approximately leo 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 acctwith th les and regulations of San Joaquin County and subject to inspection and approval. <br />41iro <br />o Applicant -Title Date <br />