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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10/11/23 <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 />(400) 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 />10/30/2023 TO 12/30/2023 DRIVEWAYS: <br />Mathews Rd. <br />French Camp QUAD SW <br />Aerial Work <br />SS/WW <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 s_ _side of — — wManhews Rd _ _ _ approximately_ _?o_ _Ffeef/Qmile_AV <br />of Bright Rd _ wench camp by performing the following work (description of work): <br />Replace overhead facilities on Dole <br />PA445946302 <br />5from EP & 10' ROW <br />Work will commence on or after_ — — — 10/30/43 _ _ _ _ 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 />7%� �l.CLBiL <br />Signature of Applicant - Title <br />10/1123 <br />Date <br />