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APPLICATION FOR ENCROACHMENT PERMIT <br />Date 2444/,,12- Revised 6/22/22 <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 35282693 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on ounty highway right-of-way on <br />the East side of S. Leeward Way approximately 713 0 feet/ ©mile North <br />of Erb Way Tracy , by performing the following work (description of work): <br />Traffic control to upgrade transformer and instag-3€-b4x- <br />installinq two 3E box (24"x36"), replacing concrete Tx pad with new box pad. We have boring at loc_2 and loc_4 <br />Work will commence on or after 5/1/22 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 />L�a� Z_zz��� <br />Signature of Applicant - Title <br />-21442-2 Revised 6/22/22 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />730052 REF # <br />APN <br />CR# <br />EXP. DATE <br />VALID672372022 <br />TO 11 112OZ3 DRIVEWAYS: <br />STREET <br />Leeward My <br />AREA <br />Tracy QUAD <br />TYPE <br />ore, Fiore Pis, Traffic Control evices <br />FORMS <br />R-29 <br />---- ALL WORK <br />Special Conditions <br />WITHIN DIRT SHOULDER-, NO PAVEMENT CUTS ---- <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on ounty highway right-of-way on <br />the East side of S. Leeward Way approximately 713 0 feet/ ©mile North <br />of Erb Way Tracy , by performing the following work (description of work): <br />Traffic control to upgrade transformer and instag-3€-b4x- <br />installinq two 3E box (24"x36"), replacing concrete Tx pad with new box pad. We have boring at loc_2 and loc_4 <br />Work will commence on or after 5/1/22 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 />L�a� Z_zz��� <br />Signature of Applicant - Title <br />-21442-2 Revised 6/22/22 <br />Date <br />