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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 8-13-21 <br />To'. San Joaquin County <br />Department of Public Works <br />PG&E <br />(Applicant Name) <br />6121 Bollinger Canyon Road <br />(Mailing Address) <br />San Ramon, CA 94583 <br />(City, State, Zip Code) <br />(925),719-0071 <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 />Sketch (Detailed plans may be submitted) <br />JOB# <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />OFFICE USE ONLY <br />730052 NET fI <br />CR A <br />11/l/2021To 1/1/2022 <br />Airport Way <br />DRIVEWAY& <br />` <br />AREA <br />TYPE <br />Manteca QUAD <br />nnwn GuyR An& An�R€lac <br />SW <br />` <br />one <br />FORMS <br />NOTES <br />SS/VNN <br />Special Cond tons <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 excavate, construct and/or otherwise encro hh on County Highway Right -of -Way on <br />the North side of Airport Way approximately 7u ee mile Northeast <br />of Kasson Road San Joactum County CA, by performing the following work (description of work), <br />Replace down auv and anchors on two Doles. First pole A030/246 located at 37.67474, -121.26915. <br />Pnlp An3n/9dR is 99 ft from Pdgp of navpmpnt and ZZ it from RC)VV <br />Pole A031/249 is 43 ft from edge of pavement, and 46 ft from ROW <br />PM#74012507 <br />Work will commence on or after 11/1/2021 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 />Permit Facilitator <br />Signature of App cant <br />8-13-2021 <br />Dale <br />