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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10/21/23 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35475406 <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 />TO 511512024 DRIVEWAYS: <br />ac�oo ay & Pueblo Dr. <br />Manteca QUAD SE <br />Trench <br />SS/ VW, R-5, R-6, R-29, Trench cut Policy <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 side of Blackfoot Way & Pueblo Dr approximately Qesc <br />mile <br />of , by performing the following workription of work): <br />Emergency Permit to trench 450' across Street & Sidewalk to install 4" conduit from 14910 Pueblo Dr going East <br />along curb to 6268 Blackfoot Way. Approx. 7 days needed. Restoration to take place after <br />Work will commence on or after 11/15/23 - 5/15/24 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 />WG%I:C/GQ/2� /G�7Qi2.l.{Ld <br />Signature of App scant - Title <br />Y:IFORMS & TEMPLATESENCROACHMENT PERMIT APPLICATION. doc (08108) <br />10/21/23 <br />Date <br />