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APPLICA'� ON FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />To: <br />San Joaquin County <br />Department of Public Works <br />PG&E PM 351:. !�03 <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 />?,;do 5;L REF # <br />CR # <br />l; to <br />Z OS 2a TC1 911,s Za DRIVEWAYS: <br />gyp• <br />4:s�ltTaAl QUAD ll� <br />7:2pzz ,ir6PIArI✓ <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 />V111wemberthrough March <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the West side of Alpine Rd approximately 3 140' ee mile North <br />of Eight Mile Rd Stockton by performing the following work ( escription of work): <br />Pole replacement, install overhead service into private prope <br />Work will commence on or after <br />0 for approximately b months 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:IPORMS & TEMPLATESIENCROACHMENT PERMIT APPLICATION.doc <br />1/29/20 <br />Date <br />