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APPLICATION FOR ENCROAChIMENT PERMIT <br />PLEASE PRINT: <br />To; <br />Cl" Joaquin County <br />Department of Public Works <br />PG&E r 35137074 <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 />013# <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />VA00 50a.� 4 REF # <br />CR # <br />41 /S to <br />fo DRIVEWAYS: <br />Age <br />QUAD zc5 <br />/Vx". 04:51LE <br />.��/`vy✓ <br />*i <br />Crew to call SJ County Inspector at (209) 953-7421 48 to 7� hortra �_�:=,�'���I_� work staris, <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 Co my Highway Right -of -Way o <br />the West/East side of S Oro Ave approximately 154' %Zda' ee mile �'v2r�l <br />of Eagle Crest Ave Stockton by performing the following work (escription of work); <br />LOC 1 -Install new pole, AT&T to remove old pole <br />LOC 2 - Install new pole and run service wire on to LOC 1 <br />Work will commence on or after 3/5/20 - 09/5/20 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 Ap <br />-Title <br />Y:IFORMS 8 TEMPLATESIENCRCACHMENT PERMIT APPLICATION.doo (OBI00) <br />2/13/20 <br />Date <br />