Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 11m22 <br />To: San Joaquin County <br />Department of Public Works <br />Pacific Gas & Electric- Candice Laccetri <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@pge com / STDivpgepennits(cDpge corn <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />PM 35294711 <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 <br />REF # <br />CR # <br />TO DRIVEWAYS: <br />Ca, din .1 Ave. <br />QUAD ES <br />a oe- ie -in) <br />bb/VVVV, K-29, 1 rent u oicy <br />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 Ean side of sCaminal Ave approximately 435Qfeet/ ©mile Norcn <br />of Meadowood Dr srodaon by performing the following work (description of work): <br />Traffic control to perform tie in for new ods service. <br />Work will commence on or after_ — — — 12/10/22 _ _ _ _ for approximately_ — reo_ days. <br />I, the undersigned, certitythat I am the owner of the respective property, oram qualified to representthe 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 />11/722 <br />Signature of Applicant - Title <br />Date <br />