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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 8 Electric <br />(Applicant Name) <br />3136 Boeing Way, Stockton <br />(Mailing Address) <br />Stockton, Ca, 95204 <br />(may, state, zip code) <br />40831611767 <br />(Area Code - Telephone Number) <br />STDI VPERM ITS@pge.com <br />(Email Address) <br />JOB# <br />APN <br />OFFICE USE ONLY <br />730052 REF# <br />CR # <br />EXP DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />5/1/2024 TO 11/1/2024 DRIVEWAYS. <br />Corral Hollow Rd ' <br />_ QUAD <br />Aerial Work Y <br />FORMS <br />NOTES <br />ssnnnnr <br />Special Conditions <br />Sketch (Petaled plans may be submitted) <br />ct <br />9'T <br />s <br />zr� � <br />The undersi ned hereby applies for ermission to c le, construct andlor otherwise encroach on County Highwaayy Right -0f- ay on <br />the side of w' approximately tet. fBeVlnile <br />of r�' —/ vs < <� by performing the following work ( escription of work): <br />Work will commence on or after — 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 />"Si9 aduWaf Applicant- TWe Date <br />1�•M.•�IYinn 11,1 ♦�Y'fi i1=Y'FtV�re.v (H,e <br />