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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 1/16/21 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 84014420 <br />(Applicant Name) E-237 <br />1524 N Carpenter Rd <br />(Mailing Address) <br />Modesto, CA 95351 <br />(City, State, Zip Code) <br />209-857-0181 <br />(Area Code - Telephone Number) <br />WAT8@PGE.COM <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 />730052-4 REF # <br />CR # <br />2/15/2021 TO 7/1/2021 DRIVEWAYS: <br />Various Roads (listed below) <br />Fcralnn QUAD SE <br />Traffic Control Devices <br />SSAA/VV <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 />November through March <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the side of approximately ee ile <br />of , by performing the following work ( escription of work): <br />Above eround survev of the Transmission Gas oioeline. A small crew will walk alone the <br />pipe taking electronic readings with hand-held devices. <br />Work will commence on or after 2/15/21- 6/17/21 for approximately 6 months days. <br />I, the undersigned, certify 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 />Signature of App scant - Title <br />V]FORMS&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />1/16/21 <br />Date <br />