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APPLICATION FOR <br />ENCROACHMENT PERMIT <br />PLEASE PRINT. <br />Dale aW -7-) L 2 7 <br />JOB # <br />OFFICE USE ONLY <br />730052 REF # <br />To: San Joaquin County <br />Department of Public Works <br />APN <br />CR # _ <br />EXP. DATE <br />PGE PM# 35316889 <br />VALID <br />STREET <br />7/25/2m TO 1/25/2024 <br />Augusta St. <br />(Applicant Name) <br />AREA <br />WoodbridQANAD NW <br />3136 Boeing Way <br />TYPE <br />FORMS <br />Aerial Work <br />SSAAAA/ <br />_ <br />(Mailing Address) <br />NOTES <br />Special C:nnd tinnc <br />Stockton Ca, 95206 <br />(City, State, Zip Code) — — <br />(408) 316-1767 <br />(Area Code - Telephone Number) <br />STDivPGEPennits@pge.com <br />(Email Address) <br />DRrVEWAYS: <br />SketchT plans may be submitted) <br />1� ]kV% <br />CL--�'L <br />11� <br />Flow q' <br />The undersigned hereby applies forp�ennission to excavate, construct and/or otherwise encroach on County highway right -of -"y on <br />the 3 side of approximately_ I® feet/Qmile <br />Of p ff2n)ec 5-r m by performing the following work (description of work): <br />3 /L, V-{ .vim I t t ge. )a <br />Work will commence on or after - -,-z5 for approximately tso 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 regulations of San Joaquin County and subject to inspection and approval. <br />re of Applicant aTitle Date <br />