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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To: San Joaquin County JOB # REF # <br />Department of Public Works APN CR # <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />STREET * <br />AREA QUAD * <br />TYPE * <br />FORMS <br />NOTES <br />(City, State, Zip Code) <br />(Area Code - Telephone Number) <br />(Email Address) <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br />the ______________ side of ___________________________________ approximately ___________________ feet/mile _________ <br />of _______________________________________, ____________________, by performing the following work (description of work): <br />Work will commence on or after _____________________________________ for approximately ________________________ 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 of Applicant - Title Date <br />Y:\FORMS & TEMPLATES\ENCROACHMENT PERMIT APPLICATION.doc (08/08) <br />Sketch (Detailed plans may be submitted) <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 />10/6/2022 <br />(Applicant Name) <br />(Mailing Address) <br />10/6/2022 <br />PG&E - Danielle Newman <br />4155 E Childs Ave <br />Merced, CA 95341 <br />209-446-0003 <br />stdivpgepermits@pge.com <br />North Grooms Rd 200 feet East <br />Henry Rd Oakdale <br />30051 Grooms Rd, Oakdale <br />PG&E to install overhead equipment on existing pole and bring new service to customer. <br />No excavation to take place. <br />PM#35308798 <br />12/1/2022 1