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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 8/10/23 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35440486 <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 />rgll@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 />8/17/2023 TO 2/17/2024 DRIVEWAYS: <br />Lone Tree Rd. <br />Escalon QUAD SE <br />Pole Replacement <br />SS/WW <br />Special Cond 0 tions <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-Waon <br />the North side of Lone Tree Rd approximately 840 ee mile South <br />of S. Van Allen Rd Escalon by performing the following work (escription of work): <br />Pole replacement Hardset West and maintenance. <br />Work will commence on or after 8/17/23 -2/17/24 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 />A�Iuld ��� <br />Signatur of Applicant - Title <br />Y:IFORMS & TEMPLATESENCROACHMENT PERMIT APPLICATION.dx (08108) <br />8/10/23 <br />Date <br />