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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 4/10/23 <br />To: San Joaquin County <br />Department of Public Works <br />Pacific Gas & Electric <br />(Applicant 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. COM <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 />Ryde Ave. <br />Stockton QUAD CC <br />Aerial Work <br />SSMNV <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 w_ _side of — — NRvae Ave_ _ _ _approximately– _130_ _Qfeet/ ® mile – "_ <br />of Del Rio or covnfryavh J by performing the following work (description of work): <br />Replace overhead facilitates on pole <br />PMA31578951 <br />Approx. 2from sidewalk & 6' from EP <br />Work will commence on or after_ — — — 5/15/23 _ _ _ _ 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 />4/1023 <br />Signature of Applicant - Title <br />Date <br />