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Is1ifWRO _� LRI 9 1 -• MROP Z•I:IIN1171 RfiW» 7i►iIII <br />PLEASE PRINT: <br />Date 1/31/20 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35135123 <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 />WATB@PGE.COM <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREEToaywpy <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />73oo51-A REF # <br />CR # <br />4A 40 <br />Zi zo TO 41 zo DRIVEWAYS: <br />Ta Al QUAD NS <br />AP, AG 2Ak44L <br />' 55;Ij ml <br />S �G L'o.clDrria�� <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 East side of S Broadway �e �-r approximately ee mile <br />of N Broadway Ave Stockton by performing the following work ( escription of work): <br />Remove transformer booster, install composite cross arm &pin insulator. <br />**All overhead work <br />Work will commence on or after 2/15/20 - 08/5/20 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:IFGRMS & TEMPLATESIENGRCACHMENT PERMIT APPLICATICN.doc <br />1/31/20 <br />Date <br />