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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/4/2024 <br />To: San Joaquin County <br />Department of Public Works <br />Pacific Gas and Electric - PM 35298206 <br />3136 Boeing Wa <br />Stockton, CA 95206 <br />(City, State, Zip Code) <br />(209) 470-2300 <br />(Area Code - Telephone Number) <br />STDivPGEpermits@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 />3/6/2024 TO 9/6/2024 DRIVEWAYS: <br />Grange Ave. <br />Woodbridge QUAD <br />Bell Hole <br />SS/WW, R-29, Trench Cut Policy, R-5, R-6 <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 EAST side of Grange Ave approximately 65 -Feet mile NORTH <br />of Tuxedo Ave , Woodbridge by performing the following work (description of work): <br />PG&E to excavate 5' x 5' bell hole to replace 3/4" STL gas service with 1/2" PL service via insert. <br />Pre/Post construction CCTV inspections may take glace. <br />Work will commence on or after 3/6/2024 for approximately 180 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 />!` 3/4/2024 <br />Sig , ure # Applicant - Title Date <br />Y:IFORMS & TEMPLATESIENCROACHMENT PERMIT APPLICATION.doc (08/08) <br />