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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10-18-2021 <br />To'. San Joaquin County <br />Department of Public Works <br />PG&E, PM 708180476 <br />(Applicant Name) <br />6121 Bollinger Canyon Road <br />(Mailing Address) <br />San Ramon, CA 94583 <br />(City, State, Zip Code) <br />(650)379-9294 <br />(Area Code - Telephone Number) <br />ET PG E P E R M I T S@ P G E. C O M <br />(Email Address) <br />may <br />JOgg <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPEraTaffic <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730052 REF# <br />CR A <br />11312022 TO 2111201 DRIVEWAYS <br />Crocker Rd. ` <br />Stockton QUAD SW ` <br />Erol Devices ` <br />SS W <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 />Novemberthrough March <br />The undersigned hereby applies for permission to excavae, construct and/or otherwise encroach on County Highway Right-of-WaV on <br />the East side of Crocker Road approximately 1,835 ee mile South <br />of S Vvillow Glen Rd San Joaquin County CA., by performing the following work (escdption of work)', <br />Overhead Electric Tower Painting Project <br />A taro is Dlaced out 20 feet in each direction at the base of the tower 0.5526 to catch any Daint/debris. <br />Tnwer'c -15 it from pd gp of navpm plot and -95 it from RC)VV Tmmpr Incatinn is 47 Ad6995r1A91 r1Ad1 d <br />Workwill commence on or after 1/3/2022 for approximately 1 days. <br />I, the undersigned, codify 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 />pPermit Facilitator <br />Signature of Applicant - Title <br />10/18/2021 <br />Dale <br />