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PLEASE PRINT: <br />APPLICATION FOR ENCROACHMENT PERMIT <br />Date 10-5-22 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E <br />(Applicant Name) <br />4055 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 <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 />Crew to call SJ County Inspector at (209) 953-7421 48 to 72 hours before work starts. <br />When calling, crew shall request "rain clearance" for any work during winter months <br />November through March <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 Plymouth Rd approximately ee mile s <br />of Oxford way Stockton , by performing the following work (c escription of work): <br />Replace overhead facilities on pole. No excavation. Traffic Control. <br />PM#45121256 <br />Work will commence on or after 11-16-22 for approximately days. <br />1, 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,6-� F Ozl Permit Facilitator 10-5-22 <br />Signature of App cant -Title Date <br />y vs SIEYWAlES£JICFO,lCVeu P wFR W,6.c W: ) <br />