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�Evie <br />APPLICATION FOR ENCROACFIMENT PERMIT <br />PLEASE PRINT: <br />Date 10/31/19 <br />To: San Joaquin County <br />Department of Public Works 35152394 <br />PG&E PM 35n8er-7[] <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 />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />'73UU'�r? 4 REF # <br />CR # <br />ii ► 0 Co I 7o DRIVEWAYS; <br />�/�u o i Q) 660 go)> * <br />iIPorJ QUAD 5t^ <br />iUb'tAU N0�/�ROv�? SERU?C <br />5s GVIi/ <br />"4SW6)19 . e4Pb/nDNS" <br />Crew to call SJ County Inspector at 1;209) 953�7�21 �a to "l� hours befiore 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 W Ripon Rd approximately 821' ee mile west <br />of S Highland Ave Ripon by performing the following work ( escrfption of work). <br />PG&E to install underground service wire into applicant installed conduit & Replace pole In Same hole <br />Work will commence on or after, 12/1/19 - O5/25/2D 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 tf�e rules and regulations of San Joaquin County and subject fo inspection and approval, <br />Signature of Applicant -Title <br />1'.IFOFi4i 8 TEV?LATESD;t'R0.;SH'.'2R F'EAViT 6PF11CAT10;1 <br />10/31/19 <br />Date <br />