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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 12/16/23 <br />PM 35495405 <br />To: San Joaquin County 35495412 <br />Department of Public Works <br />PG&E 35495415 <br />35495416 <br />(Applicant Name) 35495417 <br />3136 Boeing Way 46007560 <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 />12/30/2023 TO 6/30/2024 DRIVEWAYS: <br />River Rd. <br />R;„„„ QUAD SE <br />Pole Replacements & Aerial Work <br />SS/WW <br />Spemnl 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 Multiple Locations approximately ee ile <br />of Manteca , by performing the following work ( escription of work): <br />LOC 1 & 6 - Pole replacement, hardset west of existing, overhead work <br />LOC 2 - Pole replacement, hardset west of existing <br />LOC 3 - Pole replacement, hardset south east of existing <br />LOC 4 - Pole replacement, hardset west of existing <br />LOC 5 - Pole replacement, hardset East of existin <br />Work will commence on or after 12/30/23 6 20 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 />Signature of App scant - Title <br />V]FORMS&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />12/16/23 <br />Date <br />