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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10-13-2021 <br />To'. San Joaquin County <br />Department of Public Works <br />PG&E, PM 44961296 <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 />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730052 REF# <br />CR A <br />TO DRIVEWAYS <br />--go s <br />Escalon QUAD NE <br />Aerial Work & Traffic Control DemcAs <br />S <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 -Way on <br />the South side of Dodds Road approximately 2,250 ee in Wes[ <br />of Cometa Rd San JoaguJn County CA, , by performing the following work (description of work)', <br />Overhead Tower Repair Work <br />PG&E to do aerial work to repair cotter key and insulator eauioment on electric tower 038/237. Crew eauioment to be <br />staged on road shn rider and wit enrrnarh 'ntn n ihl'a RO\4/ of nndde Rd Tower'e -94 feet from r'ght nfway cne prl'ne, <br />-19 fppt firm Ppnf edgp App nhnf oc pnd TCP \Ne request fhpf np,m if hp \�l'd far Qn d�vc <br />Workwill commence on orafter 11/23/2021- 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 />qPermit Facilitator <br />Signature of Applica t -Title <br />1011312021 <br />Dale <br />