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PLEA$ P n- <br />APPLICATION FOR ENCROACHMENT PERMIT <br />Date -amn <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 />STDivPGEPermits@pge.00m <br />(Email Address) <br />JOB# <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />OFFICE 115E ONLY <br />730052 REFk <br />CR k <br />7/20/2023 TO 1/20/2024 DRIVEWAYS: <br />Rrennan Rd ' <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />Fccalnn QUAD <br />Aerial VVnrk _ <br />gSIVVV <br />SE <br />Sketch (Detailed ans maybe sub ided) <br />v � � <br />LJ 4- <br />\ <br />-NA <br />4,yc <br />The unders goad hereby applies for �rmission to excavate, Coryylrucj and/or otherw se encroach on Coun highway right-of-way on <br />the — side of Hh c� /Y approximately ZS G feed 0mile <br />Of. by pedorming the following work (description of work): <br />S a l�m <br />Work w 11 commence on or after – zo - 2 for approximately 180 days. <br />I, the undersigned, certify that I am th je:74th ective property, or am qualified to represent the owner and agree to do the <br />work described above in acro r e with the rules and re t ons of San Joaquin County and subject to inspection and approval. <br />�-7-Il-z? <br />mature of Applicant - Title Date <br />