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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 1/6/20 <br />To; San Joaquin County <br />Department of Public Works <br />PG&E i�M 35040906 <br />(Applicant Name) <br />1524 N Carpenter Rd <br />(Mailing Address) <br />Modesto, CA 95351 <br />(City, State, Zip Code) <br />209-557-0181 <br />(Area Code -Telephone Number) <br />WAT8@PGE.COM <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />Crew to call SJ County Inspector at (209) 953-74?1 �.�� tc� �l;> hours l���u`"�;�a�°r� work siarts. <br />When calling, crew shall request "rain clearance" for any work during winter months <br />November through Marc <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the East side of Pennant Dr approximately 55ee mile South <br />of W Banner St Lodi , by performing the following work (description of work): <br />Install new #6 Box and run primary wire underground installation of pad mount transformer. <br />Bollards are required only on the south and east sides. By locating the transformer within 3.5' of the curb as shown <br />below that should move bollards outside of the County ROW. <br />Work will commence on or after 02/1/20 - 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 8 TEMPLATESIENCRCACHMENT PERMIT APPLICATICN.doc (08108) <br />1/6/20 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />7 49d: rl164 REF # <br />APN <br />J CR # <br />EXP.DATE <br />VALID <br />I ao <br />®p TO ell ;q DRIVEWAYS: <br />STREET <br />MVVA/wr D,e. <br />AREA <br />XOP QUAD <br />TYPE <br />Vf!fL.L 14c;L I Ota A& <br />FORMS <br />NOTES <br />dncr.&W� Az- z9 <br />"45F9e.JoI <br />U, <br />klo jLA0Z,0-S LZDwE )ita/x/ <br />ZIV <br />Crew to call SJ County Inspector at (209) 953-74?1 �.�� tc� �l;> hours l���u`"�;�a�°r� work siarts. <br />When calling, crew shall request "rain clearance" for any work during winter months <br />November through Marc <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the East side of Pennant Dr approximately 55ee mile South <br />of W Banner St Lodi , by performing the following work (description of work): <br />Install new #6 Box and run primary wire underground installation of pad mount transformer. <br />Bollards are required only on the south and east sides. By locating the transformer within 3.5' of the curb as shown <br />below that should move bollards outside of the County ROW. <br />Work will commence on or after 02/1/20 - 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 8 TEMPLATESIENCRCACHMENT PERMIT APPLICATICN.doc (08108) <br />1/6/20 <br />Date <br />