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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/16/20 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 44157215 <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 />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 />13W50t.q REF# <br />CR # <br />!o rS' o <br />0 20 DRIVEWAYS: <br />ES <br />QUAD A145 <br />AAek <br />i✓n/ <br />"15AX�qe� 6A&WMd& <br />construct and/or otherwise encroach on County <br />approximately 1,300' <br />Highway Right -of <br />ee mile <br />-Way on <br />South <br />of <br />E Underwood Rd <br />Acampo by performing <br />the following work (escription <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 />hereby applies for permission to excavate, <br />side of N Sowles Rd <br />construct and/or otherwise encroach on County <br />approximately 1,300' <br />Highway Right -of <br />ee mile <br />-Way on <br />South <br />of <br />E Underwood Rd <br />Acampo by performing <br />the following work (escription <br />of work): <br />Repair cap bank. all overhead work <br />Work will commence on or after 4/1/20 -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 />Signature of Applicant -Title <br />3/16/20 <br />Y(FORMS&TEMP WSTNCROACNMEM PERMMKICATION tl PM) <br />Date <br />