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PLEASE P <br />BOIL] <br />I . <br />Date Z 3 <br />To: San Joaquin County <br />Department of Public Works <br />PGE <br />(Applicant Name) <br />3136 Boeing Way <br />(Mailing Address) <br />APPLICATION FOR ENCROACHMENT PERMIT <br />Stockton Ca, 95206 <br />(City, State, Zip Code) <br />(408) 316-1767 <br />(Area Code - Telephone Number) <br />STDivPGEPermits@pge.com <br />(Email Address) <br />may <br />DRIVEWAYS' <br />The u 'tgned hereby applies for permission to excavfJte construct and/or otherwise encroach on County highway right-of-yay on <br />the > side of r approximately 2 S o O feet/ Qmile P <br />Of 6utk 1 , J vw ; NJ �,. by performing the following work (description of work): <br />Work will commence on or <br />I, the undersigned, certify that I <br />work described above in acwrc <br />-Cs tor approximately 180 days. <br />eiwtrtef-" -e respective property, or am qualified to represent the owner and agree to do the <br />with the rul nd regulations of San Joaquin County and subject to inspection and approval. <br />of Wicant - Title <br />ate <br />730052 REF# <br />JOB # <br />— <br />APN <br />CR # — <br />EXP.DATE <br />VALID <br />TO 4 <br />STREET <br />ung Rd. <br />AREA <br />Farmington QUAD <br />TYPE <br />o�eplacement <br />FORMS <br />SS/VVVV <br />NOTES <br />SDecial Conditions <br />DRIVEWAYS' <br />The u 'tgned hereby applies for permission to excavfJte construct and/or otherwise encroach on County highway right-of-yay on <br />the > side of r approximately 2 S o O feet/ Qmile P <br />Of 6utk 1 , J vw ; NJ �,. by performing the following work (description of work): <br />Work will commence on or <br />I, the undersigned, certify that I <br />work described above in acwrc <br />-Cs tor approximately 180 days. <br />eiwtrtef-" -e respective property, or am qualified to represent the owner and agree to do the <br />with the rul nd regulations of San Joaquin County and subject to inspection and approval. <br />of Wicant - Title <br />ate <br />