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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/24/20 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM X5119057 <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 />REF # <br />CR # <br />1^ /</J;D <br />g /6 610 to DRIVEWAYS: <br />sr. # 114APM& &Ay <br />ezorje.&emA) QUAD A/5 <br />FbtE A5ptAC4gAA6w ' 4 AERJAl evAdle. <br />WAV! <br />"tjwe..P/94 e' X1DMj>AbO' <br />Crew to call SJ County Inspector at (2�9) 953-7421 4$ to 72 hour�� ��������� w��rh sfiarts. <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 approximately ee mile <br />of Corner of N Filbert St & E Harding Way Stockton by performing the following work ( escription of work): <br />Pole replacement set in same hole <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 />2/24/20 <br />Signature of Applicant -Title Date <br />Y:IFCRMS &TEMPLATESIENCROACHMENT PERM"APPLICATI(OBIOS) <br />