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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRI <br />Date 1/13/20 <br />To: San Joaquin County <br />Department of Public Works <br />PU0( PM 43481156 <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 />7&O yea -14 REF # <br />CR # <br />811120 <br />Z 20 Lro S 20 DRIVEWAYS: <br />JZD• <br />mdv t jclyn/ QUAD 55 <br />of E A;tru&rbL4r L%AL <br />wid <br />"Sr�c�AC, Cb.O.OrPANS" <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 North side of Loomis Rd approximately 1,454' ee mile West <br />of 99 Frontage Rd Stockton by performing the following work (cescription of work): <br />LOC 1- Re -align existing pole, set in same hole <br />LOC 2 -Adjust sagging overhead wire <br />Work will commence on or after 2/5/20 - 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 APPLICATION.dac (8108) <br />Date <br />