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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 4/22/23 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 45715503 <br />(Applicant Name) <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 />WATS@PGE.COM <br />(Email Address) <br />may <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 <br />REF # <br />CR # <br />TO DRIVEWAYS: <br />Main St. <br />oc on QUAD <br />Aerial Work <br />SSNWV <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 _ South side of — _ E Main St _ approximately— _ 919'_ ee mile _East_ <br />of _ New Water Rd — — – Stockton_ , by performing the following work (escription of work): <br />maintenance work on existing pole. NO GROUND DISTURBANCE WILL TAKE PLACE <br />Work will commence on or after_ — — 2/ -112123 — _ for approximately— _ 6months_ _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 cant - Title <br />urovus areurovESENCROACHMENT PERM T APPLICATION P.A(POPE) <br />4/22/23 <br />Date <br />