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7AVVItIMMIMO ARR" I,lPl_ ►�i0►uljl <br />PLEASE PRINT: <br />Date 2/7/20 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35152560 <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.CCM <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 />73WREF # <br />CR # <br />�' t J;L0 _ <br />3 it 2.e TO qf, i; DRIVEWAYS: <br />04dA.V"*QV '06% <br />5017�ckm,J QUAD X15 <br />,4E&,4G G. zg le <br />.5,5/W"J <br />1;,5 6e, r4 C de�)z)M60sk <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 East side of N Broadway Ave approximately 3,328 ee mile South <br />of Waterloo Rd Stockton by performing the following work ( escription of work): <br />Replace transformer and overhead service <br />Work will commence on or after 3/1/20 - 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 />2/7/20 <br />Signature of Applicant •Title Date <br />Y:IFCRMS 8 TEMPLATESIENCRCACHMENT PERMIT APPLICATICN.doc (08108) <br />