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APPLICATION FOR ENCROACHMENT PERMIT <br />Date -3t3&2±- Revised App 6/8/22 <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 />PM 35296644 <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 />5/11/2022 TO 11/15/2022 DRIVEWAYS: <br />Austin Rd. <br />Manteca QUAD SE <br />Traffic Control Devices & 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 Both side of Austin Rd & Hwy 99 approximately O feet/ Q mile <br />of 3 Manteca , by performing the following work (description of work): <br />Traffic control to relocate poles and electric facilities <br />Work will commence on or after 5/11/22 for approximately 180 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 />4�gw-,,2 Revised 6/8/22 <br />Date <br />