Laserfiche WebLink
PLEASE PRINT: <br />APPLICATION FOR ENCROACHMENT PERMIT <br />Date 7 -20 -2 - <br />To: San Joaquin County <br />Department of Public Works <br />PG&E <br />(Applicant Name) <br />4155 E Childs Ave <br />(Mailing Address) <br />Merced, CA, 95341 <br />(City, State, Zip Code) <br />(408) 605-6657 <br />(Area Code - Telephone Number) <br />DDHNAPGE.COM <br />(Email Address) <br />Sketch (Detailed plans may be <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730052-5 REF # <br />CR # <br />1071 /2-027— <br />9/15/2020 TO 10/1/2020 DRIVEWAYS: <br />Henry Rd. <br />Escalon QUAD SE <br />e�Te <br />SSNNV, R-29, Trench Cut Policy <br />Special Conditions <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 otherwise encroach on County Highway Right -of -Way on <br />the NE side of Henry Rd approximately A INT ee mile <br />of E River Rd I , by performing the following work ( escription of work): <br />Excavate 5'x5' bell hole for UG gas work <br />Work will commence on or after 9/15/20 for approximately 1-2 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 />7�� 7/20/20 <br />Signature of App cant • Title Date <br />Y 1FCRltSdIEYPIAIES£1'.GiOACHI£RP VRL.R'li ICRi10!Ids h:LTa) <br />