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Permit Fec: MOM <br />230 S. Sterling Dr, STE 100, Mountain House, CA 95391 <br />TEL(209) 831-2300 FAX(209)83-1-5610 <br />ENCROACHMENT PERMIT <br />Issue Date <br />Start Date <br />Permit Duration <br />Expiration Date <br />Extension <br />EP 17-18 1 17 <br />1/8/2018 <br />118/2018 - <br />5/30/2018 _ <br />Permitee: Greg Washington / Michelle McKinney Encroachment Type (please check) <br />Company: PGE <br />❑ Boring ❑ Road work <br />Address: 4040 West Lane b 'Temporary'Trfli <br />ac Control <br />Stockton, CA ❑ Trenching El <br />Phone: (925) 393-8770 Fax: 0 Other Utility Gas Work <br />M11CSD shall receive notice at least two working days prior to beginning any work, backfill or resurfacing within the <br />MHCSD right of way. For Commercial/industrial sites, the Stormwater Maintenance Agreement and <br />Commercial/Industrial Building Deposit and Reimbursement Agreement must be approved before issuing the EP. <br />Location of _ <br />wo]-N: N/S of Grant Line Rd 2696ft west of Central Pkwy <br />Description or (Install Deep Well Anode, Plans and Details submitted <br />%rm•k: <br />(Please attach <br />plans) <br />Special All boring / trenching will be per Cal OSHA standards, steel plating for safely and security during work. Equipment and field <br />Instructions: vehicels will be staged 'off street/ road". ATT will be responsible for contacting any other agencies or entities for additional <br />(To he filled approvals. Permittee and Company above will abide by MHCSD General Provisions listed on Encroachment Permit Application. <br />by iLIHCSO) Any emergencies to include damage from boring to utilities, traffic, equipment to be reported immediately to MHCSD This permit <br />Is specifically for Location of Work specified within this permit.Separate permit submittals to include details (specs, direction, <br />(distance, depth, etc.) will be required for any additional locations. Date of the actual work will be determined per designated day <br />within work week and weather permitting. Call MHCSD when actual date and time work will be performed, (at leat 48hrs prior, <br />unless emergency repair/work). All work, repairs and traffic control will adhere to State of California D.O.T. Traffic Control <br />Sysytem Plans. <br />Inspector(s): ❑ Avtar Bansal (209) 831-5630 Cedric Hathorn (209) 831-5606 <br />Permitee agrees to comply with requirements and conditions in the NIHCSD GENERAL PROVISIONS which are made <br />a part of hereof and attached hereto. <br />Avtar Bansal edric Hatboro <br />Sr. Public Works Inspector <br />By — -- By- — <br />Date: A <br />mill- - <br />Special Approval (Required for Commercial and Comments/ mditions: 'SieAojddta pen-.n-bal K); S810U8813 <br />Industrial) JeW IMlu00 •stuawaj!nbeJ p ua!le1Aap <br />Jo uo!ss!wo Am eAoidde JO azuoylne lou seop <br />Signature inq -usld s!yl uo pagposep pue unmoys s! <br />431LIM 113L14 of Klux sPuMxa IeAotdde SILU <br />Print Name <br />i LOItilSla S301!*,N3S AlINf11NVV <br />oo <br />AGH NIVI Nnon <br />03AOdddd --- <br />