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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 72723 <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 />STDivPGEPermits@pge com <br />(Email Address) <br />may <br />PM 35458400 & PM 35429042 <br />JOB# <br />APN <br />EXR DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730052 REF# <br />CR# <br />TO DRIVEWAYS: <br />�e ler�d <br />Acampo QUAD NE <br />Aerial Work & Anchor Replacerrient <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 _ South _ side of _ — — E Peltier Rd _ _ _ _ approximately _ o e — ®feed 0mile _ --- <br />of <br />-_of Iv Elliott RdAampo by performing the following work (description of work): <br />Traffic control to replace anchor, transformer & install new OH service <br />Work will commence on or after– — — — 9/1/23— — — for approximately— — ,eo_ _ 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 />(gyp,— 72723 <br />Signature of Applicant - Title <br />