Laserfiche WebLink
APPLICATI®N FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date <br />To: <br />12/27/19 <br />San Joaquin County <br />Department of Public Works <br />PG&E PM 35142186 <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 />V006 REF# <br />CR # <br />g i i4 <br />Igo 2b TO I zo DRIVEWAYS: <br />oi3Ag7r <br />$drGehToni QUAD SS <br />'£!54L�W�t4. --t'Agkktr <br />A5eA-A,��, �� 'T&,b W e5ae� Macy <br />Crew to call SJ County Inspector at (`�p9) 9 �a37�„� 1 � �3 �c >l'�? hours � �'wc�hk starts. <br />When calling, crew shall request "rain clearance” for any work during winter months <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the South side of Hobart Ave approximately 105' ee mile East <br />of S Walker Ln 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 1/30/20 - 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:IFCRMS & TEMPLATESIENCROACHMENT PERMIT APPLICATIDN.dac (OBI08) <br />12/27/19 <br />Date <br />