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PLEASE PRINT: <br />APPLICATION FOR ENCROACHMENT PERMIT <br />Date 12-29-22 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E <br />(Applicant Name) <br />4055 E Childs Ave <br />(Mailing Address) <br />Merced, CA 95340 <br />(City, State, Zip Code) <br />(408)605-6657 <br />(Area Code - Telephone Number) <br />DDHN@PGE.COM <br />(Email Address) <br />Sketch (Detailed plans may be <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 />TO 6/1/2023 DRIVEWAYS: <br />McCracken Rd. <br />Tract/ QUAD SW <br />Aerial Work <br />SS/WW <br />Special Conditions <br />Crew to call SJ County Inspector at (209) 953-7421 48 to 72 hours before work starts. <br />When calling, crew shall request "rain clearance" for any work during winter months <br />November through March <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the E side of S McCracken Rd approximately 45' ee mile S <br />of S Greenwood Rd Tracy , by performing the following work ( escription of work): <br />Replace overhead facilities on pole. No excavation. <br />No drawing available, only picture <br />8' From EP & 18' From Centerline <br />Work will commence on or after 2-1-23 for approximately 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 />Dav F, Ozl Permit Facilitator 12-29-22 <br />Signature of App cant -Title Date <br />Y 1FCRltSdIEYPIAIES£1'.GiMAC UuP VR L�R'li ICAW16d p:L ) <br />