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APALICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />10/31/19 <br />To; San Joaquin County <br />Department of Public Works <br />PG&E PM 35085529 <br />(Applicant Name) <br />1524 N Carpenter Rd <br />(Mailing Address) <br />Modesto, CA 95351 <br />(City, State, Zip Code) <br />20M57-0181 <br />(Area Code •Telephone Number) <br />WATS@PGEECOM <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />Crew to call SJ County Inspector <br />When calling, crew shall r1quj <br />11111116 <br />The undersigned hereby applies <br />the North side of <br />of S Highland Ave <br />JOB # <br />APN <br />EXP, DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />'�j , , L} REF # <br />CR # <br />(r, <br />i2 I 0 Co J zo DRIVEWAYS; <br />U�6r Q, Poo ee> <br />;?/Pofi QUAD 5E <br />TA)Sbri l NDI.a904+ S'61200( <br />G A/ <br />"��G1Y9L L'D rn'O " <br />a <br />1� <br />95'1421 48 to 72 hours before work starts. <br />in cle ante" for any work during winter months <br />bevl <br />hrouan March <br />cavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />m Rd approximately 82�' ee mile West <br />Ripon by performing the following work ( escription of work); <br />PG&E to install underground service wade into applicant installed <br />Worlc will commence on or <br />I, fhe undersigned, cei <br />work described abov� <br />Sigihature of <br />Y:IFORA1S 8iE1.W SIEIICROACHNEIRP <br />for approximately <br />days. <br />ithat I am the owner of the respective property, or am qualified to represent the owner and agree to do the <br />accordance with the rules and regulations of San Joaquin County and subject to inspection and approval, <br />10/31/19 <br />Date <br />