Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT; <br />Date 1/2/20 <br />To; San Joaquin County <br />Department of Public Works <br />PG&E PM 35142188 <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 />NCITES <br />OFFICE USE ONLY <br />Voo5X 4 REF # <br />6 CR # <br />E31 f I zc) <br />2S Zo To of Azo <br />S tsci A Q AJEO <br />45;y -:bra N QUAD !ES <br />mp:mE ot.E T,2Etik�+-t <br />c lV-W. g4 TzEAk�',ur- <br />e,!,vkM>rr)p05ti <br />DRIVEWAYS: <br />?N41cy. <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 Sinclair Ave approximately 600' ee mile South <br />of Washington St Stockton by performing the following work ( escription of work): <br />excavate (1) 4' x 4' bell hole; trench for new has service <br />Work will commence on or after 1/25/20 - 07/25/20 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 />Signature of Applicant -Title <br />Y:IFORMS 8 TEMPLATESiENCROACHMENT PERMIT APPLICATION.dac (08108) <br />1/2/20 <br />