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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/28/23 <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) 0050057 <br />(Area Code - Telephone Number) <br />DDHN@PGE.COM <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 />4/20/2023 TO 7/1/2023 DRIVEWAYS: <br />Thornton Rd. <br />Lodi QUAD NW <br />Pole Replacement <br />SSMNV <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 _ — EThornton Rd _ _ _ approximately _ °-45 — Q feet/ ® mile _ s_ <br />_side of <br />of — — — _Rile Rd _ _ _ _ rod_ _ by performing the following work (description of work): <br />PMA31500773 <br />9from EP & 21' from Centerline <br />Work will commence on or after_ — — — 4/20@3— — — _ 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 />32823 <br />Signature of Applicant - Title <br />Date <br />