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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/7/20 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35137076 <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 />7, im 4 REF # <br />CR # <br />yh 40 <br />:AI1200 jr 1 TO jyj 10 DRIVEWAYS: <br />, <br />¢v QUAD <br />1A1sArA?Z, L waQk ' <br />"iq Cdc,ViT/A <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 />November through March <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 E Brandt Rd approximately 130' ee mile East <br />of N Taylor Ranch Rd (private road) , Lockford , by performing the fglowing work ( escription of work): <br />Install new aole and transformer; Install overhead service wire into private property <br />Work will commence on or after 2/,e9'/� - 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:IFORMS & TEMPLATESIENCRCACHMENT PERMIT APPLICATICN.doc (00108) <br />2/x/20 <br />Date <br />