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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 5/16/23 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 45760644 <br />(Applicant Name) <br />3136 Boeing Way <br />(Mailing Address) <br />Stockton, CA 95204 <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 REF # <br />CR # <br />6/20/2023 TO 12/20/2023 DRIVEWAYS: <br />Finck Rd. <br />Tract/ QUAD SW <br />Aerial Work <br />SS/A/W <br />Special Conditions <br />5/10/23 <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 Ri ht -of -Way on <br />the South side of Finck Rd approximately 3.63 fee mile West <br />of S Tracy Blvd Tracy by performing the following work (description of work): <br />maintenance work on existing pole. NO GROUND DISTURBANCE WILLTAKE PLACE <br />Work will commence on or after 6/20/23 - 12/20/23 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 />1) , 14y4Aai2e <br />Signature of App scant - Title <br />V]FORMS&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />5/16/23 <br />Date <br />