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PLEASE PRINT: <br />SJC-Sexton Bridge Project <br />PM 35238286 <br />APPLICATION FOR ENCROACHMENT PERMIT <br />Date 11/10/2021 <br />To: San Joaquin County <br />Department of Public Works <br />PGE <br />(Applicant Name) <br />560 West 15th Street <br />(Mailing Address) <br />Merced, CA 95340 <br />(City, State, Zip Code) <br />209.355.5087 <br />(Area Code - Telephone Number) <br />CYSO@pge.com <br />(Email Address) <br />may <br />See attached <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP.DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <br />This work will extend North of East River Rd and south of Lane Oak Road on Sexton Rd. <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 Sexton Rd approximately feet/mile <br />of , by performing the following work (description of work): <br />HGE o move all poles approx 1 Uto the East of existing poles, complete and install all UH electrical services. Install <br />new poles at new locations. I rench and baCktiiiand place conduit and pull service cables and new splice <br />ox. e ai s on Uonstruction urawing, ruiz call outs in BLUE boxes <br />Work will commence on or after 11/20/2021-06/30/2022 for approximately 21 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 />'!Ya ad <br />Signature of Applicant - Title <br />V]FORMS&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />11/10/2021 <br />Date <br />