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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3+1924 <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 />STDjvPGEPemits@pge.com <br />(Email Address) <br />JOB # <br />APN <br />EXP DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730052 REF # <br />CR # <br />TO DRIVEWAYS: <br />B St. ' <br />QUAD -- ' <br />Aerial Work ' <br />ssnlwv <br />Special Conditions <br />Sketch (Detailed plans may be submitted) <br />Ls�rS <br />I =s2 >e ) n <br />c <br />The undersigned hereby applies for pem fission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the west side of a s1 approximately 391 Q feet/ Qmile North <br />of Ralph A" smanoo by performing the following work (description of work). <br />To mpaT i <br />46045407 <br />Work will commence on or after 61124 for approximately +w 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 />3119124 <br />Si atueof plicant-Title <br />Date <br />