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PG&E - 74058483- R-1952 - SURVEY <br />APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/15/24 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E - TY CAULK PERMIT FACILITATOR <br />3136 BOEING WAY <br />(Applicant Name) <br />(Mailing Address) <br />STOCKTON , CA 95126 <br />(City, State, Zip Code) <br />(408) 313-0963 <br />(Area Code - Telephone Number) <br />JN23@PGE.COM / STDIVPERMITS@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 />71812024 <br />TO DRIVEWAYS: <br />Roth Rd <br />QUAD <br />Traffic Control Devices <br />SS/VWV <br />S—pecial Conditions <br />*SEE ATTACHED DRAWING AND TRAFFIC PLANS FOR WORK DETAILS <br />THIS REQUEST IS FOR TRAFFIC CONTROL ONLY <br />NO GROUND DISTURBANCE, ONLY SURVEY WORK TAKING PLACE. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the NORTH side of E ROTH RD approximately 1000 0 feet/ 0 mile EAST <br />of S MCKINLEY AVE Lat: 37.855642 Long: -121.266031 , by performing the following work (description of work): <br />0 <br />PG&E TO CONDUCT SURVEY WORK ON PRIVATE PROPERTY, REQUEST IS FOR TRUCKS ENTERING AND EXITING ROADWAY TO CONDUCT SURVEY <br />Work will commence on or after 4/8/24 for approximately 3 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 />Ty Caulk Digitally signed by Ty Caulk te3/15/24 <br />Da: 20111:56:21 -07'00' <br />Signature of Applicant - Title <br />Date <br />