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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 12/27/19 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35136127 <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 />q 000j 4 REF # <br />i CR # <br />Ali z6 <br />I 1A TO 12.0 TO 20 DRIVEWAYS: <br />?e4)x l> y1 ke=Ipt>� Rp . <br />-yrue.WT&o QUAD jlll!WtP�5 <br />�ot�P�ACkMEbSi /1��1RLtJo�a <br />&J <br />'See�e1)A CPP"bIT) 0S)S`' <br />Crew to call SJ County Inspector at (209) 953-7421 48 to 7� 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 side of Corner of Pocl< Ln &Mariposa Rd approximately ee mile <br />of _ Stockton by performing the following work ( escription of work): <br />Pole and overhead service wire replacement <br />Work will commence on or after <br />- 07/25/20 for approximately 6 months nays. <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 />Signature of Applicant -Title <br />Y:IFORMS & TEMPLATESIENCROACHMEMT PERMIT APPLICATION.doc (08100) <br />12/27/19 <br />Date <br />