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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/17/20 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35148798 <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 />(Detailed plans may be submitted) <br />JOB# <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 />0/S 2A <br />9gs yo T /0 rS o DRIVEWAYS: <br />LA/a" <br />:5Tdok73A1 QUAD A/6 <br />�� ,e6Ft Ac6rrlEor, A6¢rr9l.� <br />Ml24 <br />" <br />permission to excavate, construct and/or otherwise encroach on County Highway Right -of <br />Viola Ave approximately 218' ee mile <br />-Way on <br />South <br />of <br />E Fremont St <br />Stockton <br />by performing the following work ( ascription <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 <br />the <br />undersigned hereby applies far <br />East side of <br />permission to excavate, construct and/or otherwise encroach on County Highway Right -of <br />Viola Ave approximately 218' ee mile <br />-Way on <br />South <br />of <br />E Fremont St <br />Stockton <br />by performing the following work ( ascription <br />of work): <br />Pole and service wire replacement <br />Work will commence on or after 4/25/20 - 10/5/20 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 />�v�iy7, ira 3/17/20 <br />Signature of App cant •Title Date <br />rMONMS d TEAW MSENMWHA KPE MFW LMTIOKtl (OM) <br />