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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/15/23 <br />To: San Joaquin County <br />Department of Public Works <br />Pacific Gas & Electric - Candice Laccetti <br />(Applicant Name) <br />1524 N. Carpenter Rd <br />(Mailing Address) <br />Modesto, CA 95351 <br />(City, State, Zip Code) <br />(925) 303-9471 <br />(Area Code - Telephone Number) <br />C6L5@pge.com / STDivpgepermits@pge.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />IWLTA c�7ci :3��irl <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />730052 <br />5/10/2023 <br />Currier Dr. <br />Tracy <br />Traffic Control <br />SSNWV <br />OFFICE USE ONLY <br />REF # <br />CR # <br />TO 11/10/2023 DRIVEWAYS: <br />QUAD Sw <br />Devices <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the West side of Currier Dr approximately 120 _ (F feet/ ()mile south <br />of Redondo Dr Tracy by performing the following work (description of work): <br />Traffic control to install breakers <br />Work will commence on or after 4/10/23 <br />for approximately <br />180 <br />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 />3/15/23 <br />Signature of Applicant - Title <br />Date <br />