Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/21/20 <br />To: an Joaquin County <br />Department of Public Works <br />PG&E PM 35148095 <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 />FORMSg5/4 <br />NOTES <br />OFFICE USE ONLY <br />7.36Vsoa- 4 REF # <br />CR # <br />/S 2G <br />Wj 20 F T 41/1!r/20 DRIVEWAYS: <br />96WV KD. <br />Ei5e4gAAn/ QUAD <br />da(*41WA%OA C <br />4 <br />/9L pJaC4 <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 East side of Henry Rd approximately 5,234' ee mile North <br />of HWY 120 Escalon , by performing the following work (description of work): <br />INSTALL BRACKET TO HOLD 1 PHASE & 3 PHASE TRANSFOMER, NO GROUND DISTURBANCE BY PG&E <br />APPLICANT TO INSTALL NEW SERVICE POLE/PANEL <br />Work will commence on or after 3/5/20 - 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 to inspection and approval, <br />�, �i2e 2/21/20 <br />Signature of App scant •Title Date <br />Y,WONMS &TEM TES1 NMR HF WPEN P =TIONd tU j <br />