Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/1523 <br />To: San Joaquin County <br />Department of Public Works <br />Pacific Gas & Electric <br />Name) <br />4155 E Childs Ave <br />(Mailing Address) <br />Merced, CA 95340 <br />(City, State, Zip Code) <br />(408) 6056651 <br />(Area Code - Telephone Number) <br />DDHN@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 />3/24/2023 TO 5/15/2023 DRIVEWAYS: <br />Greenwoord Rd. <br />Tracy QUAD SW <br />Pole Replacement Aerial Work <br />SS/WW <br />Special Conditions <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the __Ivw — side of — — screenwood Rd _ _ _ approximately_ _moo_ _ Ffeef/Qmile_ s_ <br />of sMcCzd<en Rdyernens by performing the following work (description of work): <br />Replace pole & overhead facilities <br />6from EP & 18' from Centerline <br />PM445577832 <br />Work will commence on or after_ — — — 3/24/23 _ _ _ _ for approximately_ — 1— _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 />Da�cG�IL 3/1523 <br />Signature of Applicant - Title Date <br />