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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 5-10-21 <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 />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730052 REF# <br />CR A <br />&Hi2921 81112021 <br />TO DRIVEWAYS <br />ova ` <br />TracyQUAD Sw <br />Mrol Devil <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 North side of Lovely Road approximately 700 ee mile \Alpgt <br />of South Bird Road San Joaquin Cpunty CA ,by performing the following work( escdption ofwori <br />Minor diaaina around tower Dole for foundation maintenance. <br />FP 'c annrnx 94 facet form trnaar and RC)\A/'c annrnx 9q facet frnm trnaar <br />PM# 40745896 <br />Work will commence on or after 6/1/2021 for approximately 2 days. <br />I, the undersigned, codify mail 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 />LI Permit Facilitator <br />Ignalure of Applicant - Title <br />5/10/2021 <br />Dale <br />