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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date <br />2/24/20 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E Pli✓I 35142148 <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 />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />73oo5J A REF # <br />CR # <br />ze <br />3 iS 20 TO 9 i5 20 DRIVEWAYS: <br />&/e/FelCk ,rzD. <br />A eANJFb QUAD NE <br />cc- g,6, Aciee4t-.7r :t A&44'A L, N ckk. <br />5s,/s✓v✓ <br />—` c�14G C'rNDrno,ts' <br />Crew to call SJ County Inspector at (209) 953-7421 4� to �2 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 I<enneficl<Rd approximately 2,191' eetmile North <br />of Acampo Rd Acampo by performing the following work ( escription of work): <br />Pole realacement and overhead service replacement <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 />1 1011 <br />Signature of Applicant -Title <br />Y:IFORMS 8 TEMPIATESIENCROACHMENT PERMIT APPLICATION.doc (08108) <br />2/24/20 <br />Date <br />