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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 8/7/21 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 74037547 <br />(Applicant Name) C-1747 <br />1524 N Carpenter Rd <br />(Mailing Address) <br />Modesto, CA 95351 <br />(City, State, Zip Code) <br />209-857-0181 <br />(Area Code - Telephone Number) <br />WAT8@PGE.COM <br />(Email Address) <br />may <br />JOB 4 <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730052 REF 4 <br />CR 4 <br />2/10/2022 TO DRIVEWAYS: <br />Von Sosten Rd. <br />Tracy QUAD SW <br />Bell Holes, Trench <br />SSAAdN, R-29, Trench Cut Policy <br />Special Conditions <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 Von Sosten Rd approximately 155' ee mile East <br />of Los Ranchos Dr Tracy , by performing the following work (iascdption ofwork)_ <br />Install Deep well Anode. Rectifier and pole. <br />Work will commence on or after 8/19/21 - 2 25 21 for approximately 6 months 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 />Signature cant - Title <br />YVOWS&frWLAfrcEWG Am WWPEWI.wPUa 10mm=Pue) <br />8/7/21 <br />Date <br />