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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 1/13/20 <br />To; San Joaquin County <br />Department of Public Works <br />PG&E PM 43480135 <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 />70do rd - 4 REF # <br />CR # <br />14t2,0 <br />211 L2o TO 9 Za DRIVEWAYS: <br />ST. <br />QUAD 55 <br />44,4Z ZAAO ek <br />S5/iWAO/ <br />� apL40AIWM446 " <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 South side of 10th St approximately 505' ee mile East <br />of Bieghle St Stockton by performing the following work ( escription of work): <br />replace overhead cross -arm; All overhead work <br />Work will commence on or after 2/1/20 - 8/25/20 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 <br />-Title <br />Y:IFCRMS 8 TEMPLATESIENGROACHMENT PERMIT APPLICATICN.doc <br />1/13/20 <br />Date <br />