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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 1/24/23 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35496049 <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 />1/31/2024 TO 7/31/2024 DRIVEWAYS: <br />Baker Rd. <br />Linden QUAD <br />Pole Replacement <br />ssNvvv <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 South side of Baker RD approximately 295' 2(escription <br />mile West <br />of N. Jack Tone Rd , Linden — , by performing the following work of work): <br />Work will commence on or after 1/31/24 -7/8/24 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 />Abu,-� 1/24/24 <br />Signatur of Applicant - Title Date <br />Y:IFORMS & TEMPLATESIENCROACHMENT PERMIT APPLICATION.Ax (08/08) <br />