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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 6/15/23 <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) 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 />7/24/2023 TO 12/24/2023 DRIVEWAYS: <br />Peltier Rd. <br />Lodi QUAD NW <br />Replace Guy Wire <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 _ _ P _ _ side of _ — — _ Peltier Rd _ _ _ _ approximately _ _110_ _ Ffeef/ Qmile _ - <br />of gg Frontage Rd _ Lodi by performing the following work (description of work): <br />Replace guy wire on pole. No Excavation <br />PMri44303618 <br />4 t EP, 18 to Centerline & 16 to ROW <br />Work will commence on or after_ — — — /22423 _ _ _ _ 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%al� �yi 6/1523 <br />Signature of Applicant - Title Date <br />