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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 102523 <br />To: San Joaquin County <br />Department of Public Works <br />Candice Lacceth PG&E <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 />STDivPGEPennits@pge corn <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />PM 35474468 <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 />12/0512023 TO DRIVEWAYS: <br />QUANTASLANE <br />STOCKTON QUAD SE <br />AERIALWORK <br />SS/WVV <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 _ _ Both — side of _ — — ooanfas Ln _ _ _ _approximately _ 0 53 _ ®feetl Qmile _ soom <br />of Arch Arporc Hd --------,----Stockton----, by performing the following work (description of work): <br />Traffic control only to install new pole and OH span of service. (All work on private property) <br />Work will commence on or after_ — — — 12/5/23— — — _ for approximately_ — ieo---- 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 />(�usGUC.� <br />Signature of Applicant - Title <br />102523 <br />Date <br />