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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 9-13-2021 <br />To'. San Joaquin County <br />Department of Public Works <br />&E, PM 70040802 <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 />JOB# <br />APN <br />EXP.DATE <br />VALID <br />STREEToc�T17n <br />OFFICE USE ONLY <br />730052 REF# <br />CR A <br />101 Tp DRIVEWAYS <br />` <br />AREA <br />TYPE <br />Stockton QUAD <br />Rory Pits. Bora <br />SS ` <br />` <br />FORMS <br />NOTES <br />SSAVVVR-29 <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 encro hh on County Highway Right-of-WaV on <br />the East side of Pock Ln approximately uuu ee mile South <br />of Carpenter Rd Stockton San Joaquin Cpunty CA., by performing the following work (escdption of work), <br />Stockton A to Weber Sub Fiber Install Project- Underground Work <br />PG&E / Contractor to bore on shoulder of ROWto install new 4" SCHD. 40 conduit and Dull new trace wire. 3 -cell <br />Workwill commence on or after 10/18/2021 for approximately 5 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 />4/ /r Permit Facilitator <br />Signature of o"f App -Tule <br />09/13/2021 <br />Dale <br />