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PLEASE PRINT: <br />APPLICATION FOR ENCROACHMENT PERMIT <br />Date 11/22/22 <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 DRIVEWAYS: <br />QUAD WS <br />Traffic Control Devices <br />SS/WVV <br />bpecial 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 S side of Scotts Ave approximately ee mile W <br />Of s Pergh' gAve Stockton , by performing the following work (escription of work): <br />Portion of Traffic control will be on SJ County ROW. Replace pole in Stockton ROW. No excavation in County ROW. <br />No drawing available only picture <br />PM#31494677 <br />Work will commence on or after 1/3/23 for approximately 1 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-ed 7, ,Oe, Permit Facilitator 11/22/22 <br />Signature of App scant - Title Date <br />Y 1FCRltSdIEYPIAIESfI'.GiOACHIE'R P VRt CAW16s p:L ) <br />