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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 6/20/23 <br />To: San Joaquin County <br />Department of Public Works <br />Pacific Gas & Electric <br />(Applicant Name) <br />4155 E Childs Ave <br />(Mailing Address) <br />Merced, CA 95340 <br />(City, State, Zip Code) <br />(408) 6056657 <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 />717/2023 TO 12/7/2023 DRIVEWAYS: <br />Peltier Rd. <br />Lodi QUAD NW <br />Aerial Work <br />SSNWV <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the sside ofWPeioerrm_ _ _ _approximately e Qfeet/ ®mile E <br />of — — Devries Rd _ _ _ Lod, by performing the following work (description of work): <br />Replace overhead facilities on pole <br />PMA31520019 <br />N EP, 18Centerline & 16' POW <br />Work will commence on or after_ — — — 70/23— — — _ 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 />62023 <br />Signature of Applicant - Title <br />Date <br />