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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 7/11/19 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35052102 <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 />Sketch (Detailed plans may be submitted) <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />OFFICE USE ONLY <br />73005A- REF # <br />CR # <br />11112. <br />SI&T TO DRIVEWAYS: <br />Zos A zr--s <br />AREA <br />TYPE <br />aJ QUAD t S <br />Al -e w A Z6-rU.VrAZZ <br />FORMS <br />NOTES <br />e- P-4 <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 LOS ANGELES ST approximately 251' ee mile North <br />of W Sonora St Stockton , by performing the following work ( esription of work): <br />replace pole in same hole; same size pole <br />Work will commence on or after 8/1/19 - 12/15/19 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 />Li/LQiL %G 1iurtlg <br />Signature of App scant - Title <br />YAFORMS & TEMPLATESIENCROACHMENT PERMIT APPLICATI ON.doc (09108) <br />7/11/19 <br />Date