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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/27/2023 <br />To: San Joaquin County <br />Department of Public Works <br />Pacific Gas and Electric - PM 44339080 <br />kik[.". <br />Stockton, CA 95206 <br />(City, State, Zip Code) <br />(209)470-2300 <br />(Area Code - Telephone Number) <br />STDivPGEpermits@pge.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />REF # <br />CR # <br />TO DRIVEWAYS: <br />QUAD <br />Crew to call SJ County Inspector at (209) 953-7421 48 to 72 hours before work starts. <br />When calling, crew shall request "rain clearance' for any work during winter months <br />November through March <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the _SOUTH_ _side of — WAQne Ave_ _ approximately_ 143'&195' — ee mile EAST_ <br />of_ Delaware Ave _ _ _ __ Stockton_ by performing the following work(description ofwork): <br />PG&E to excavate (2) 14" keyholes to install ETS, valve box and cover on gas distribution carrier and casing pipe. <br />Pre/Post construction CCN inspections may take place. <br />Work will commence on or after_ — _12023— — — for approximately— _180— — — 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 rules and regulations of San Joaquin County and subject to inspection and approval. <br />2/27/2023 <br />Sigogure if Applcant - Title Date <br />