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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 11-1-2019 <br />To; San Joaquin County <br />Department of Public Works <br />PGE PM 35136045 <br />(Applicant Name) <br />3136 Boeing Way <br />(Mailing Address) <br />Stockton, CA 95204 <br />(City, State, Zip Code) <br />(209) 210-0454 <br />(Area Code - Telephone Number) <br />T8M3@PG ,,COM <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP, DATE 1 <br />VALID Z q TO •; iy- Lo DRIVEWAYS: <br />STREET IAWqljr <br />AREA QUAD /y1� <br />TYPE 756(.[r t4OLE, TRENCH LPA✓eD Aa <br />FORMS <br />NOTES C.�gLCplVorT�all2i" <br />Crew to call SJ County Inspector at (209) 953-7421 48 to 72 hours before work starts. <br />When calling, crew shall request "rain clearance" for any work during winter months <br />November through March <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the south side of E Augusta st approximately Iso feet/mile West <br />of Olive St Woodbridge, CA 95258 by performing the following work (description of work): <br />New gas service - 1 inch HPPL <br />Work will commence on or after �zi�izo�9 <br />for approximately <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 />T. W Ma1�k <br />l�rez <br />Signature of Applicant -Title <br />Y:IFORMS 8 TEMPLATESIENCROAGNMENT PERMIT APPLICATION.doc (OB/OB) <br />11-1-2019 <br />Date <br />Crew to call SJ County Inspector at (209) 953-7421 48 to 72 hours before work starts. <br />When calling, crew shall request "rain clearance" for any work during winter months <br />November through March <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the south side of E Augusta st approximately Iso feet/mile West <br />of Olive St Woodbridge, CA 95258 by performing the following work (description of work): <br />New gas service - 1 inch HPPL <br />Work will commence on or after �zi�izo�9 <br />for approximately <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 />T. W Ma1�k <br />l�rez <br />Signature of Applicant -Title <br />Y:IFORMS 8 TEMPLATESIENCROAGNMENT PERMIT APPLICATION.doc (OB/OB) <br />11-1-2019 <br />Date <br />