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P�S�RIN APPLICATION FOR ENCROACHMENT PERMIT <br />Date <br />To: San Joaquin County <br />Department of Public Works <br />PGE <br />(Applicant Name) <br />3136 Way <br />(Mailing Address) <br />Stockton Ca, 95206 <br />(City, State, Zip Code) <br />(406)316-1767 <br />(Area Code - Telephone Number) <br />STDIvPGEPennits@pge.com <br />(Email Address) <br />Sketch (Detailed ans may be subrgitled) <br />�i <br />JOB# <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />OFFICE USE ONLY <br />730052 REF# <br />CR # <br />7/20/2023 TO 1/20/2024 DRIVEWAYS: <br />Brennan Rd. <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />Escalon QUAD SF <br />Apr al \Alnrk <br />SSNVVV <br />The undersigned hereby applies for Winossion to excavate, cor louc and/or otherwise encroach on County highway right-of-way on <br />the _ side of HH c i¢ e approximately Z16 PfeeV Omile 3 <br />of by performing the following work (description of work): <br />S 6 lI �5 <br />Work will commence on or after -1-26 - -LD for approximately 180 days. <br />I, the undersigned, certify that I am the s ecfive property, or am qualified to represent the owner and agree to do the <br />work described above in acco a with the rules and re itions of San Joaquin County and subject to inspection and approval. <br />-7- //-2 i <br />gnature of Applicant - Title Date <br />