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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 8/28/23 <br />To: San Joaquin County <br />Department of Public Works <br />Pacific Gas & Electric <br />Name) <br />4155 E Childs Ave <br />(Mailing Address) <br />Merced, CA 95340 <br />(City, State, Zip Code) <br />(408) 6056651 <br />(Area Code - Telephone Number) <br />DDHN@PGE.OGM <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 />TO 11 it 1 J2U2F DRIVEWAYS: <br />Byron Rd. <br />Tracy QUAD SW <br />Aerial Work <br />SSV <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–- N— _side of — — —By <br />Rd _ _ _ _approximately– ____ _Ffeet/ Qmile– e_ <br />of Wculund Rd Mounrain Hood by performing the following work (description of work): <br />Replace out wire no excavation <br />PM,P45563421 <br />6'EP&12'POW <br />Work will commence on or after_ — — — 9/11/23 _ _ _ _ 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 />82823 <br />Signature of Applicant - Title <br />Date <br />