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PLEASE PRINT: APPLICATION FOR ENCROACHMENT PERMIT PM 35266077 <br />Date 08/31/2021 <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 for measurements <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREETow�Jones <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730052 REF # <br />CR # <br />10/11/2021 TO DRIVEWAYS: <br />Rd. <br />Stockton QUAD SW <br />Pole Replacement <br />SSANVV <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 South-West side of W. Lower Jones Rd approximately 1.8 feet/mile North-west <br />of S Whiskey Slough Rd by performing the following work (description of work): <br />Work will commence on or after -10/1 1 /2091 for approximately 2 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 <br />V]FORMS&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />08/31/2021 <br />Date <br />