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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/18/20 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 31425887 <br />(Applicant Name) <br />1524 N Carpenter Rd <br />(Mailing Address) <br />Modesto, CA 95351 <br />(City, State, Zip Code) <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 />73oox; Z- 4 REF # <br />CR # <br />T A5 20 <br />36 z• to 4 DRIVEWAYS: <br />12�ApixT 92>0 <br />CL464c,srs QUAD Na <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 side of Brandt Rd approximately 24` ee mile West <br />of Skaggs Ranch Rd , Clements , by performing the following work ( escription of work): <br />Installing a new 200' DWA and trenching for anode, cathode and ground wires. <br />Work will commence on or after 3/1/20 - 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 <br />cant -Title <br />Y:IFCRMS 8 TEMPLATESIENCRCACHMENT PERMIT APPLICATICN.doc (88108) <br />2/18/20 <br />Date <br />