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PLEASE PRINT:. <br />Date <br />10-18-2021 <br />APPLICATION FOR ENCROACHMENT PERMIT <br />To'. San Joaquin County <br />Department of Public Works <br />PG&E, PM -44958984 <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 />ETPGEPERMITSo@pge.com/ YX080,oae.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />JOB# <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />OFFICE USE ONLY <br />730052 REF# <br />CR A <br />1 1z llzuz 1 TO DRIVEWAYS <br />Dodds Rd. ' <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />Escalon QUAD SE <br />Traffic Control Devices ' <br />SS <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 pemission to excavate, construct and/or otherwise encroach on County Highway Right-of-WaV on <br />the South side of Dodds Road approximately 1,740 ee mile Wes[ <br />of Steinegul Rd San Joactum County CA _,by perfoming the following work (description of work), <br />Traffic Control for Overhead Tower Maintenance Work <br />Pres ,.ee nyen r.mrr,. nninfirrol r„ an wnrk nin rnwar r„ re r nc-dganr stool die to unseat d orator ka}_ <br />Workwill commence on or after 11/21/2021 for approximately <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 />Permit Facilitator 10/18.2021 _ <br />Signature of App cant -Title Dale <br />