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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date <br />10/31/19 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35131197 <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 <br />JOB# <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />OFFICE USE ONLY <br />13w5&-4 REF# <br />CR# <br />U <br />II yS 14 0 1 zo DRIVEWAYS: <br />WAUCE 2. i,n/ <br />AREA <br />TYPEEF2ACG-M�tJT <br />QUAD X5 <br />6W <br />FORMS <br />NOTES <br />55 <br />' 5jer +;9J, &.7D1r*AK <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 S Walker Ln approximately 118' ee mile South <br />Of E Sonora St Stockton , by performing the following work (escription of work): <br />Work will commence on or after 11/25/19 - 04/25/20 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 />10/31/19 <br />Signature of Applicant • Title Date <br />Y:IWRSIS S 1FN UMSIFNCRCACHWEW PEAA;TA ICATICNA.(MB) <br />