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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 44170497 <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 />WATS@PGE.COM <br />(Email Address) <br />Sketch (Detailed plans maybe <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />'73pa 4 REF # <br />CR # <br />o 7.0 <br />3 Zq 0 w DRIVEWAYS: <br />47 sr <br />ST3cA=vA1 QUAD ASS <br />T�SwM6As <w <br />.QVAA,✓ ,=-24 07%eA aweo rAzle% <br />�^ i <br />permission to excavate, <br />N F St <br />construct andlor otherwise encroach <br />approximately <br />on County <br />117' <br />Highway Right -of <br />ee mile <br />-Way on <br />South <br />of <br />Mistletoe <br />Ave <br />Stockton <br />by performing the <br />following work (ae cription <br />of work): <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 <br />the East <br />restore pavement atter emergency gas leak <br />hereby applies for <br />side of <br />permission to excavate, <br />N F St <br />construct andlor otherwise encroach <br />approximately <br />on County <br />117' <br />Highway Right -of <br />ee mile <br />-Way on <br />South <br />of <br />Mistletoe <br />Ave <br />Stockton <br />by performing the <br />following work (ae cription <br />of work): <br />Work will commence on or after 3/29/20 - 9/25/20 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 />j�,yyB 3/9/20 <br />Signature of App cant -Title Date <br />Y:AM M &TEMM WSE NMOACHWtff PENMRAPPUW Mtl (O&l <br />