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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT; <br />Date 1/27/20 <br />To; San Joaquin County <br />Department of Public Works <br />PG&E PM 35144550 <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 />��-� REF # <br />CR # <br />y' <br />TO y' / as DRIVEWAYS: <br />GdoD ,- <br />4A/WpI QUAD J !W <br />;te4OA9 dMiket <br />SiJ <br />�'sPECIJf1LA1P17>blJ5'' <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 />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 Flood Rd approximately 1.20 fee mile East <br />of Escalon-Bellota Rd Linden , by performing the following work (description of work): <br />Install transformer and realace aole <br />Work will commence on or after 2/1/20 - 08/25/20 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:IPORMS & TEMPLATESIENCROACHMENT PERMIT APPLICATION.doc (00108( <br />1/27/20 <br />Date <br />