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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date /2019 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35050484 <br />Applicant <br />4040 West Lane <br />Mailing Address) <br />Stockton, CA 95204 <br />City, State, Zip Code) <br />209) 470 - 2300 <br />Area Code - Telephone Number) <br />s6pzApge.com <br />Email Address) <br />plans may be <br />JOB # <br />APNCR <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPEAC <br />FORMSA <br />NOTES <br />OFFICE USE ONLY <br />7300S2 -(o REF# <br />Z <br />TO /2 /9 DRIVEWAYS: <br />xEAA/ CO— ALE <br />AAff&C;4 QUAD <br />R R9 <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 <br />on the EAST side of Oleander Ave approximately 275' NORTH of Fig Rd, <br />Replacement of deteriorated joint pole <br />by performing the following work (description of work): <br />Work will commence on or after 6/01/2019 for approximately 180 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 />Date