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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 4/18/23 <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) 6056657 <br />(Area Code - Telephone Number) <br />DDHN@PGE.OGM <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 />5/15/2023 TO 7/15/2023 DRIVEWAYS: <br />Roth Rd. <br />Lathrop QUAD SE <br />Aerial Work <br />SSNWV <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 s— _side of — — _EHnm Rd _ _ _ _approximately– _aa0Tfeet/ 0mile– e_ <br />of A n French camp by performing the following work (description of work): <br />Replace overhead Facilities on pole <br />PMri45582603 <br />5from EP & 27' from Centerline & 19' within POW <br />Work will commence on or after_ — — — 5n5/23 _ _ _ _ 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 accordancee/ with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />D �LClBIL 4/1823 <br />Signature of Applicant - Title Date <br />