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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 311924 <br />To San Joaquin County <br />Department of Public Works <br />PGE <br />(Applicant Name <br />3136 Boemg Way <br />(Mailing Address) <br />Stockton Ca, 95206 <br />(City, State, Zip Code) <br />}408)316-1767 <br />(Area Code - Telephone Number) <br />STDwPG E Permits@pge-com <br />(Email Address) <br />JOB # <br />OFFICE USE ONLY <br />730052 REF # <br />APN <br />CR # <br />EXP DATE <br />VALID <br />STREET <br />TO DRIVEWAYS <br />Alpine Rd. <br />AREA <br />TYPE <br />QUAD <br />Aerial Work <br />FORMS <br />NOTES <br />SSAMN <br />Special Conditions <br />Sketch (Detailed plans may be submitted) <br />C3- <br />/R&7 <br />r/R&7 " r <br />The undersigned hereby applies for pemussion to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the wcs1 side of uwne approximately 11367 (F�feeUQmile s -U, <br />of Egl MRd stocldun , by performing the following work (description of work). <br />To repair and de�nerg¢e tranfom <br />46133880 <br />commence on or after u124 for approximately <br />1w <br />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 />�' %�� ,Z- 3!1924 <br />SiJriatuKe of pplicant- Title Date <br />