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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10/13/2020 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35157892 <br />(Applicant Name) <br />3136 Boeing Way <br />(Mailing Address) <br />Stockton, CA 95204 <br />(City, State, Zip Code) <br />209-279-3846 <br />(Area Code - Telephone Number) <br />s9p3(cDpge.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/v2021 <br />10/15/2020 TO2/1/2021 DRIVEWAYS: <br />Jack Tone Rd. <br />Manteca QUAD SE <br />New Pole Install & Aerial Work <br />SS/WW <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 East side of S Jacktone Rd approximately .5 feet 1( North <br />of Lone Tree Rd , by performing the following work (description of work): <br />Primary line extension to serve new OH service. PGE to remove exisiting DE crossarm at Location 1. Install 8' composite crossarm <br />Location 2: install 50' pole, 9' composite arm, DE raptor framing, 3/8" down quy with anchor. Location 3: replace 20T fuses with <br />Work will commence on or after 9/23/2020 for approximately 5 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 />10/13/2020 <br />Signature 16f Applicant - Title <br />V]FORMS&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />Date <br />