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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRIM I <br />Date 1/21/20 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 31362005 <br />pplicant Name) <br />15�!t 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 />yl)oi�. REF # <br />CR # <br />B <br />a 0 / DRIVEWAYS; <br />/,f�/yQ <br />NI,Ln/ QUAD /f�E <br />v/G nA)446 <br />55 N1 L <br />G r9G4rz2Ao1V1r1bA16 <br />Crew to call SJ County Inspector at (%09) 953-721 �!��3 to 72 hours before work starts. <br />When calling, crew shall request "rain clearance" for any work during winter months <br />November through Mare' i <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 N Wimer Rd & HWY 26 approximately ee mile <br />of Linden by performing the following work ( escription of work): <br />LOC 1-8 - install new pole and overhead service <br />LOC 9-14 - remove existing overhead service <br />LOC 17 - re 'lace fuses on existing ole <br />LOC 12 & 13 - remove poles <br />Work will commence on or after <br />for approximately b montns aays, <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 & TEMPLATESIENCRCACHMENT PERM" APPLICATICN.doo (08108) <br />1/21/20 <br />Date <br />