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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3;1s24 <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 />(409)316-1767 <br />(Area Code - Telephone Number] <br />STD1vPG EPermits@pge.com <br />(Email Address) <br />JOB # <br />730052 <br />OFFICE USE ONLY <br />REF # <br />APN <br />CR # <br />EXP DATE <br />VALID <br />STREET <br />4/1/2024 <br />est. <br />TO 1011/2024 DRIVEWAYS: <br />' <br />AREA <br />TYPE <br />Aenal Work <br />QUAD <br />' <br />FORMS <br />NOTES <br />SSNVVV <br />Special Conditions <br />is may be submitted) :i <br />,e J c,M� <br />C� <br />x <br />s <br />The undersigned hereby applies for pennission to excavate, construct and/or otherwise encroach on County highway right -0f -way on <br />the west side of est approximately 67 (j� feelf ()mile semn <br />of Mlohae� Ave slockt rI , by performing the following work (description of work): <br />To repak and de -energize trenfoaner <br />31675112 <br />commence on or after <br />4124 <br />for approximately <br />IN <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 />�1 i�Lcalurr (,vH. 311924 <br />Si4haWre of plicant-Title Date <br />