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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 54123 <br />To: San Joaquin County <br />Department of Public Works <br />Pacific Gas & Electric- Candice Lacceth <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 />C0L5@pgecom / STDivpgepennits@pge com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />PM 35423120 <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 />6/1/2023 TO 12/1/2023 DRIVEWAYS: <br />Nowell Rd. <br />Thornton QUAD NW <br />Aerial Work <br />GGAAAA/ <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the–_ wen — side of — — NNoweu Rd_ _ _ _approximately– _z4s_ _ Qfeet/ Qmile_ Boom <br />of — — _ W New Hope Rd--------, ----Thornton----, by performing the following work (description of work): <br />Traffic control to install OH transformer & service. <br />Work will commence on or after_ — — — 6/1/23— — — _ for approximately_ — _160_ _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 />5/4/23 <br />Signature of Applicant - Title <br />Date <br />