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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 1/24/20 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35146324 <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 />WATB@PGE.COM <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREETX1t#a1&J60 <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />nzsa.t� REF # <br />CR # <br />15/d? & <br />a yv Td DRIVEWAYS: <br />,eD. <br />QUAD *416 <br />ovG A doe e <br />5S moi✓ <br />°5/2G/y7C Coi✓�lTiaa/S'• <br />Crew to call SJ County Inspector at (209) 953-7421 4� 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 excavafe, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the East side of Alpine Rd approximately 250' ee mile North <br />of E I<ettleman Ln , Lodi , by performing the following work ( escription of work): <br />lace Recloser on existing pole; all overhead work <br />Work will commence on or after 2/25/20 - 08/5/20 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 8 TEMPLATESIENCROACHMENT PERMIT APPLICATION.doc (08108 <br />1/24/20 <br />Date <br />