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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To:San Joaquin County JOB #REF # <br />Department of Public Works APN CR # <br />EXP. DATE <br />VALID TO <br />DRIVEWAYS: <br />(Applicant Name)STREET * <br />AREA QUAD <br />* <br />TYPE * <br />(Mailing Address)FORMS <br />NOTES <br />(City, State, Zip Code) <br />(Area Code -Telephone Number) <br />(Email Address) <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 ___________________________________ approximately ___________________ feet/mile _________ <br />of _______________________________________, ____________________, by performing the following work (description of work): <br />Work will commence on or after _____________________________________ for approximately ________________________ 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 Applicant -Title Date <br />Y:\FORMS & TEMPLATES\ENCROACHMENT PERMIT APPLICATION.doc (08/08) <br />Sketch (Detailed plans may be submitted) <br />730052 <br />5/10/2024 11/10/2024 <br />Seminole Way <br />Traffic Control Devices <br />SS/WW <br />Special Conditions <br />3136 Boeing Way <br />Stockton, CA 95204 <br />209-857-0181 <br />WAT8@PGE.COM <br />PM 31690020 <br />4/15/24 <br />4/15/24 <br />6 _______________________ days._______________________ days.months_______________________ days._______________________ days.5/10/24 - 12/10/24 <br />150'the ______________ side of ___________________________________ approximately ___________________ feet/mile _________the ______________ side of ___________________________________ approximately ___________________ feet/mile _________SouthWay on Way on <br />the ______________ side of ___________________________________ approximately ___________________ feet/mile _________the ______________ side of ___________________________________ approximately ___________________ feet/mile _________ <br />Yuma of _______________________________________of _______________________________________Wayof _______________________________________of _______________________________________ <br />Eastthe ______________ side of ___________________________________ approximately ___________________ feet/mile _________the ______________ side of ___________________________________ approximately ___________________ feet/mile _________Seminole the ______________ side of ___________________________________ approximately ___________________ feet/mile _________the ______________ side of ___________________________________ approximately ___________________ feet/mile _________the ______________ side of ___________________________________ approximately ___________________ feet/mile _________the ______________ side of ___________________________________ approximately ___________________ feet/mile _________ <br />Manteca, ____________________, , ____________________, <br />Maintenance on existing existing UG electric facility. facility. facility. facility. NO GROUND DISTURBANCE WILL TAKE PLACE