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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/22/23 <br />To: San Joaquin County <br />Department of Public Works <br />Gregory Washington (PGE) <br />(Applicant Name) <br />3136 Boeing Way <br />(Mailing Address) <br />Stockton , Cal 95206 <br />(City, State, Zip Code) <br />(408) 316-1767 <br />(Area Code - Telephone Number) <br />STDivPGEPermits@pge.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the North side of Bollea Rd approximately 300, Q feet/ O mile West <br />of Hwy 12 Wallace by performing the following work (description of work): <br />To complete repairs (switch) on top of pole <br />31631785 <br />Work will commence on or after 3/1/23 for approximately 180 Days 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 />2/22/23 <br />Signature of Applicant - Title Date <br />