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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10/2/2020 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E - PM 44408344 <br />(Applicant Name) <br />220 Channel St, Stockton, CA <br />(Mailing Address) <br />Stockton, CA, 95202 <br />(City, State, Zip Code) <br />925-701-1564 <br />(Area Code - Telephone Number) <br />gxjl@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 />730052-6 REF # <br />CR # <br />2/15/2021 <br />11/16/2020 TO 2/15/2021 DRIVEWAYS: <br />Cooper Rd. <br />Acampo QUAD NE <br />Bell Hole <br />rench Uutoicy <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 North side of E Cooper Rd approximately 234' feet/mile East <br />of E Frontage Rd Acampo by performing the following work (description of work): <br />PG&E to excavate 4x4 at Tee to inspect service material. If copper is found service is to be replaced. CCTV may take place. <br />Work will commence on or after 11/16/20 for approximately 4 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 />�� QB2.GL/.csL <br />Signature of Applicant - Title <br />V]FORN6&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />Date <br />10/2/2020 <br />