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APPLICATION FOR ENCROACHMENT PERMIT PLEASE PRINT: Date OFFICE USE ONLY To:San Joaquin County JOB #REF # Department of Public Works APN CR # EXP. DATE VALID TO DRIVEWAYS: (Applicant Name)STREET * AREA QUAD * TYPE * (Mailing Address)FORMS NOTES (City, State, Zip Code) (Area Code -Telephone Number) (Email Address) The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on the ______________ side of ___________________________________ approximately ___________________ feet/mile _________ of _______________________________________, ____________________, by performing the following work (description of work): Work will commence on or after _____________________________________ for approximately ________________________ days. 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 work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. Signature of Applicant -Title Date Y:\FORMS & TEMPLATES\ENCROACHMENT PERMIT APPLICATION.doc (08/08) Sketch (Detailed plans may be submitted) 3136 Boeing Way Stockton, CA 95204 209-857-0181 WAT8@PGE.COM PM 35147633 5/4/23 5/4/23 6 ________________________ days.________________________ days.months________________________ days.________________________ days.6/15/23 _____________________________ for approximately_____________________________ for approximately_____________________________ for approximately_____________________________ for approximately12/15/23_____________________________ for approximately_____________________________ for approximately Tesla dersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Rightdersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right the ______________ side of ___________________________________ approximately ___________________ feet/mile _________the ______________ side of ___________________________________ approximately ___________________ feet/mile _________Rd the ______________ side of ___________________________________ approximately ___________________ feet/mile _________the ______________ side of ___________________________________ approximately ___________________ feet/mile _________and the ______________ side of ___________________________________ approximately ___________________ feet/mile _________the ______________ side of ___________________________________ approximately ___________________ feet/mile _________Corral dersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Rightdersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right the ______________ side of ___________________________________ approximately ___________________ feet/mile _________the ______________ side of ___________________________________ approximately ___________________ feet/mile _________Hollow dersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Rightdersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right the ______________ side of ___________________________________ approximately ___________________ feet/mile _________the ______________ side of ___________________________________ approximately ___________________ feet/mile _________Rd the ______________ side of ___________________________________ approximately ___________________ feet/mile _________the ______________ side of ___________________________________ approximately ___________________ feet/mile _________ Loc 1 - Install new pole pole 45' pole pole 100' from existing existing pole. pole. trench to pvt pvt prop prop to new #7 box Loc 2 - Install new # 7 box in private prop. and pull cable through conduit by trench to location 5 Loc 3 - Uninstall anchor from existing pole Loc 5 - Install new #7 box install conduit pull cable through trench to location 11 Loc 11- Install new 45' pole and pull cable through conduit by trench from location 5 *all other locations in pvt prop