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PLEASE PRINT: <br />Date <br />3/6/20 <br />\!'PLICATION FOR ENCROACHMENT PERMIT <br />To: an Joaquin County <br />Department of Public Works <br />PG&E Pr/l 35156492 <br />(Applicant Name) <br />1524 N Carpenter Rd <br />(Mailing Address) <br />Modesto, CA 95351 <br />(City, State, Zip Code) <br />209-857-0181 <br />(Area Code -Telephone Number) <br />WAT8@PGE.COM <br />(Email Address) <br />JOB# <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />130051REF# <br />CR # <br />%611120 <br />3 tS 20 TO 110 DRIVEWAYS: <br />W OLK RD <br />fRE►xM c^,A QUAD �g <br />Ae-,"A#. W*44, <br />gy <br />S <br />Sketch (Detailed plans may be submitted) <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 <br />otherwise encroach on County Highway Right -of -Way on <br />the side of C/O S Wolfe Rd & W Mathews Rd approximaiely ee mile <br />Of , by performing the following work ( escription of work): <br />Replace switch capacitor bank on existing pole No ground disturbance <br />Work will commence on or after 3/25/20 - 09/25/20 for approximately 6 months 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 />3/6/20 <br />Signature of App scant Title Date <br />YIFO SVEMPIA7801WOKHWIR PE"WI RPPI WION E CORS) <br />