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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date <br />To San Joaquin County <br />Department of Public Works <br />Pacific Gas a Electric <br />(Applicant Name) <br />3136 Boeing Way, Smckbn <br />(61aft Address) <br />SticIdDi Ca, 95204 <br />(may, fate, Zip Cl <br />408-31611767 <br />(Area Code - Takephone Number) <br />STDI VPE R M ITS@pge.com <br />(Email Address) <br />JOB If <br />OFFICE USE ONLY <br />730052 REF If <br />APN <br />CR # <br />D(P DATE <br />VALID <br />STREET <br />5/1/2024 TO 11/1/2024 DRIVEWAYS <br />Alpine Rd. <br />AREA <br />TYPE <br />QUAD _ <br />Aerial Work ' <br />FORMS <br />NOTES <br />ssn <br />Special Conditions <br />Sketch (Detailed plans may be submitted) <br />(0' FQ <br />'✓ ;1 k <br />The undersjyped hereby applies forpermission to ex ts, con" and/or otherwise encroach on County High Right -of -Way on <br />the side of N Inrvu_ approximately ✓ ) !"'` fee ile 'ol <br />of � v - .:tz it do-. , by performing the following work asci pion of work): <br />l� Cow-,(�e ✓a �i�� r.�� C�v`.�,Sr��ti, <br />Work will commence on or after 5 for approximately 180 days. <br />I, the undersigned, tartly 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 a/,�euy U%talFiir�ta� 1 <br />L'Siy alu oftTitle Date <br />