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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/14/24 <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 />may <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP.DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the s side of E Roth Rd approximately 85 @ feet/ Q mile w <br />of Intermodal way _ Manteca , by performing the following work (description of work): <br />Location (2) Remove existing stub/anchor pole, relocate existing pole 6'S & install anchor. <br />Location (3) Remove existing stub/anchor pole, relocate existing power pole 6' S <br />Location (4) Remove existing anchor, install stub/anchor pole & install overhead span guy wire. <br />Dimensions added to the drawing in red. <br />PM#74055740 (Location 1 is city jurisdiction) <br />Work will commence on or after 4/15/24 for approximately 5-10 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 />!pav/ lGG watB'/Z 3/14/24 <br />Signature of Applicant - Title <br />Date <br />