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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/24/23 <br />To: San Joaquin County <br />Department of Public Works <br />Pacific Gas & Electric- Candice Laccetri <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 />C0L5@pgecom / STDivpgepennits@pge corn <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />PM 35355934 <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 />3/24/2023 TO 7/1/2023 DRIVEWAYS: <br />Brumby Rd. <br />Stockton QUAD NF <br />(N) Pole Install & Aerial Work <br />SSANW <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the _wen — side of — — _erumev Rd _ _ _ _approximately_ _03i0feet/ 0mile <br />__ esf <br />of Iv Highway Be ___ srnaa0n_ , by performing the following work (description of work): <br />INSTALL NEW DISTRIBUTION POLE AND TRANSFORMER, OH SERVICE 53TO CUSTOMER OWNED POLE <br />Work will commence on or after_ — — — 3/24/23— — — _ 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 />22423 <br />Signature of Applicant - Title <br />