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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/15/24 <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 />OFFICE USE ONLY <br />JOB # 730052 REF # <br />APN CR # <br />EXP. DATE <br />VALID 5/13/2024 TO 8/13/2024 DRIVEWAYS: <br />STREET Bacon Island Rd. <br />AREA QUAD <br />TYPE Traffic Control Devices <br />FORMS SS/WW <br />NOTES 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 E side of Bacon Island Rd approximately 4,000 (j) feet/ Q mile N <br />of Lower Jackson Rd Tracy by performing the following work (description of work): <br />Replace guy wire. no excavation <br />P M#46133844 <br />Approx. 12' from EP, 24' from Centerline & 4' from ROW <br />Work will commence on or after 5/13/24 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 />Z�)av�"d �G{{fi 3/15/24 <br />Signature of Applicant - Title Date <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the E side of Bacon Island Rd approximately 4,000 (j) feet/ Q mile N <br />of Lower Jackson Rd Tracy by performing the following work (description of work): <br />Replace guy wire. no excavation <br />P M#46133844 <br />Approx. 12' from EP, 24' from Centerline & 4' from ROW <br />Work will commence on or after 5/13/24 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 />Z�)av�"d �G{{fi 3/15/24 <br />Signature of Applicant - Title Date <br />