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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 9/24/19 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35091210 <br />(Applicant <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 />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 />Vea6a .4 REF # <br />CR # <br />.4Wz_0 <br />TO qISSu DRIVEWAYS: <br />SrbelciaA/ QUAD /T7 <br />fig& 44&nem� <br />Ss , ,J <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 N Ashley Ln approximately 2,436' ee mile <br />of Cherokee Rd I Stockton , by performing the following work ( escription of work): <br />Pole replacement hard set south <br />Work will commence on or after 10/25/19 - 04/5/20 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 />ctJ � <br />Signature of App cant • Title <br />Y:W MS&1 WI USTNMOACHVEM PMV MPLIGiIMN 1000 <br />9/24/19 <br />Date <br />