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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To: San Joaquin County <br />JOB # REF # <br />Department of Public Works APN CR # <br />EXP. DATE <br />VALID TO <br />DRIVEWAYS: <br />(Applicant Name)STREET * <br />AREA QUAD <br />* <br />TYPE * <br />(Mailing Address)FORMS <br />NOTES <br />(City, State, Zip Code) <br />(Area Code - Telephone Number) <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on ounty ighway ght-of-ay on <br />the ______________ side of ___________________________________ approximately ____________ feet/ mile _________ <br />of _______________________________________, ____________________, by performing the following work (description of work): <br />Work will commence on or after _____________________________________ for approximately ________________________ 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 />Signature of Applicant - Title DateSignature of Applicant -Title <br />7/30/22 <br />Pacific Gas & Electric - Candice Laccetti <br />1524 N. Carpenter Rd <br />Modesto, CA 95351 <br />(925) 303-9471 <br />C6L5@pge.com / STDivpgepermits@pge.com <br />PM 35309599 <br />Both S Hewitt Rd 1.71 <br />North <br />Hwy 4 Linden <br />Traffic control to replace OH facilities <br />10/27/22 180 <br />7/30/22 <br />730052 <br />10/27/2022 5/1/2023 <br />Hewitt Rd. <br />Linden NE <br />Aerial Work <br />SS/WW <br />Special Conditions