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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 8/13/2020 <br />To: San Joaquin County <br />Department of Public Works <br />M_ <br />(Applicant Name) <br />3136 Boeing Way <br />(Mailing Address) <br />Stockton, CA 95204 <br />(City, State, Zip Code) <br />209-279-3846 <br />(Area Code - Telephone Number) <br />s9p3(cDpge.com <br />(Email Address) <br />Sketch (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 />730052-6 REF # <br />CR # <br />12/1/2020 <br />10/5/2020 TO 12/1/2020 DRIVEWAYS: <br />Jack Tone Rd. <br />Stockton QUAD NE <br />Pole Installations, Aerial Work <br />SS/VVyV <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 East side of Jacktone Rd approximately 2,230 feet/mile North <br />of Copperopolis Rd by performing the following work (description of work): <br />Install Overhead, joint poles and equipment for new load and replace overstressed pole and isolating switch for betterment. All line <br />extension on applicant's property. <br />Work will commence on or after 10/5/2020 for approximately 5 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 />s P619,C-Z <br />Signature of Applicant - Title <br />V]FORN6&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />8/13/2020 <br />Date <br />