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PLEASE PRINT: <br />APPLICATION FOR ENCROACHMENT PERMIT <br />Date 1-25-23 <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 />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <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 w side of ValpicoRd approximately 220' ee mile w <br />of Corral Hollow Rd Tracy by performing the following work (escription of work): <br />Replace (1) pole in County ROW. Relocating it into private property. (LOC q <br />Replace (1) in private property. (LOC 2) <br />Transfer overhead service across Corral Hollow Rd <br />PM#74046580 <br />Work will commence on or after 2-20-23 for approximately 1-2 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 1-25-23 <br />Signature of App scant - Title Date <br />Y 1FCRltSdIEYPIAIESfI'.GiOACHIE'R P VRt CAW16s p:L ) <br />