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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date <br />Το : <br />2/26/20 <br />San Joaquin County <br />Department of Public Works <br />PG&E ΡΜ 31438367 <br />(Applicant Name) <br />1524 Ν Carpenter Rd <br />JOB # <br />ΑΡΝ <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />ΤΥΡΕ <br />OFFICE USE ONL Υ <br />? 3tJ υ!fa~ 4 REF# <br />CR# 1bs-1w . . <br />-s (ir(z o · Το 1/ιs/)ο <br />tl.ΙA Ne Ι<J:> f . ~ιJ.ιι,,1 Αν'Ε:. <br />~p~J<roιJ QUAD ~ <br />DRIVEWAYS: <br />* <br />* <br />* <br />(Mailing Address) <br />Modesto, CA 95351 <br />FORMS <br />NOTES <br />"'f12#f!:;Λ)α./ i/J~ <br />~ιΑΙ ι J!.. zfl. -7bαΝ ~JtP~f' <br />,._~4'"91.. /1' Α.λ)Ρ-',ιΛ ~ .(, <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 />Crew ·to call SJ County lnspector at (209) 953-7 421 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 applίes for permission to excavate, construct and/or otherwise encroach on County Highway Right -of-Way on <br />the ---~---, side of _-,,-----,--,-,-------,---approxin:iately ______ ~ee mile __ _ <br />of Corner of W Alpine Ave & Franl<lin Ανe , Stocl<ton , by performing the fol lowing work ( escription of work): <br />INSTALL Α NEW 49' SD-DWA ΟΝ ΤΗΕ SOUTH SIDE OF ΤΗΕ INTERSECTION OF W ALPINE AVE AND FRANl<LIN AVE <br />Work will commence on or after 3/25/20 -09/5/20 for approximately 6 months days. <br />Ι, 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 regu lations of San Joaquin County and subject to inspection and approval. <br />ω~Τ · <br />Signature of AppΞie 2/26/20 <br />Date <br />Y:IFORMS & TEMPLATESIENCROACHMENT PERMIT APPLICATION.doc (08108)