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APPLICATION FOR ENCROACHMENT PERMIT <br />'LEASE PRINT: <br />Date 12/27/19 <br />ro: San Joaquin County <br />Department of Public Works <br />PG&E PM 35131241 <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 />WATS@PGE.COM <br />Address) <br />plans may <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 North side of E Fairchild Rd approximately 438 ee mile West <br />Of Alpine Rd Stockton by performing the following work (escription of work): <br />pole replacement <br />Work will commence on or after 1129/20 - 07/5/20 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 />Lf/��Gati 12/27/19 <br />Signature of Applicant • Title Date <br />Y:aRMS 6 TEMPIA SOMOACHWMPEWFAPPLICATION dw(OW) <br />OFFICE USE ONLY <br />JOB # <br />'130o y'a 4 REF # <br />APN <br />CR # <br />EXP. DATE <br />7 <br />VALID <br />:111v 4 Ro 0 S u DRIVEWAYS: <br />STREET <br />k <br />FAr2tHr�� ILo <br />AREA <br />5-rdcQUAD FL4 <br />TYPE <br />f1w . R&PLA<WA*4ZT <br />FORMS <br />55V1Wd <br />NOTES <br />�uAL �n,nsas° <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 North side of E Fairchild Rd approximately 438 ee mile West <br />Of Alpine Rd Stockton by performing the following work (escription of work): <br />pole replacement <br />Work will commence on or after 1129/20 - 07/5/20 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 />Lf/��Gati 12/27/19 <br />Signature of Applicant • Title Date <br />Y:aRMS 6 TEMPIA SOMOACHWMPEWFAPPLICATION dw(OW) <br />