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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/1/24 <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)605-6657 <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 />3/22/2024 TO DRIVEWAYS: <br />Cherokee Rd. <br />QUAD <br />Pole Replacements <br />SSA" <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 side of approximately Q feet/ Q mile <br />of by performing the following work (description of work): <br />Replace (1) Pole & (1) stub pole <br />P M#35509528 <br />Stub Pole Approx. 13' EP & 2' ROW. Pole Approx. 8' EP & 8' ROW <br />Work will commence on or after 3/22/24 for approximately 1-2 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 />Da-tled � 3/1/24 <br />Signature of Applicant - Title Date <br />