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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT : <br />Date <br />Το: <br />2/11/20 <br />San Joaquin County <br />Department of Public Works <br />PG&E ΡΜ 35064909 <br />{Applicant Name) <br />1524 Ν 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 />ΑΡΝ <br />EXP .DATE <br />VALID <br />STREET <br />AREA <br />ΤΥΡΕ <br />FORMS <br />NOTES <br />OFFICE USE ONL Υ <br />13αο5ι;~// REF# <br />, J CR# <br />. elι s-J;<; . ψ ,~/.;1(, ' τό ~~/tkJ ~Ρ~Π Α γ 7 <br />"?it!A~'L_ QUAD -5iA.J <br />~w~,(}7"μz.,, ~;/ι~.Ι <br />,,~~AtL-~ff,)J~ ,ι, <br />DRIVEWAYS: <br />• <br />• <br />• <br />Crew to call SJ County lnspector at (209 ) 953 -7 421 48 to 72 hours before work starts. <br />When calling, crew shall request 11 rain clearance 11 for any work during winter months <br />November th roug h Ma rch <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 W Schulte Rd appro ximately 2050' ee mi le West <br />of Quality Rd Tracy , by performing the following work ( escription of work): <br />permit for TCP signs being put in county ROW while worl< is done in City ROW <br />Work will commence on or after ---~2~/=13~/~2~0_-~08~/~5~/2~0 ___ for approximately --~6~m~o~n=th=s~--days. <br />1, 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 />ω~r · <br />Signature of AppΞιe 2/11/20 <br />Date <br />Y:IFORMS & TEMPLA1ESIENCROACHM!ΞNT PERMIT APPLICATION .doc (08/08)