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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 7/26/23 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 45897419 <br />(Applicant Name) <br />3136 Boeing Way <br />(Mailing Address) <br />Stockton, CA 95204 <br />(City, State, Zip Code) <br />209-200-1855 <br />(Area Code - Telephone Number) <br />rgl l @ PG E. CO M <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />JOB# <br />APN <br />EXP.DATE <br />VALID <br />STREETOiPPer0P0liS <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730052 REF# <br />CR # <br />TO DRIVEWAYS: <br />R-6— <br />6AREA Linden QUAD NE <br />Aerial7( <br />SSMM <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 CopperopolisRd approximately 1,223 ...... ee ile West <br />of Dietrich Rd Linden , by performing the following work (description of work): <br />Pole maintenance , no ground disturbance to take place <br />Work will commence on or after 8/2/23 -2/2/24 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 />Signatur of Applicant - Title <br />V]FORMS&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />7/26/23 <br />Date <br />