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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/9/20 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35157085 <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 #;oosa-4 <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />REF # <br />CR # <br />411f 1e <br />C zzs TO �S io DRIVEWAYS: <br />Lt 44 arY Zp <br />GAooVAb QUAD A66 <br />xetwat l•✓w <br />y,5/ Al <br />— :Vde4AL 4oAwr!!"" <br />side of <br />Liberty Rd <br />otherwise encroach <br />approximately <br />on County <br />171' <br />Highway Right -of <br />ee mile <br />-Way on <br />East <br />Of <br />N <br />Jack <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 />the <br />Replace transformers on existing pole. No ground <br />North <br />side of <br />Liberty Rd <br />otherwise encroach <br />approximately <br />on County <br />171' <br />Highway Right -of <br />ee mile <br />-Way on <br />East <br />Of <br />N <br />Jack <br />Tone <br />Rd <br />Acampo by performing the <br />following work (description <br />of work): <br />disturbance <br />Work will commence on or after 3/25/20 - 09/5/20 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 tc inspection and approval. <br />Gf%a.�ia., <br />, %e <br />Signature of App cant -Title <br />Y:IFONMS d 1ENPU1ES1ENIXt0ACHMM PEFMR N4lIGilON E¢ (O W 8) <br />3/9/20 <br />Date <br />