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APPLICA ΤΙΟΝ 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 35143052 <br />(Applicant Name) <br />1524 Ν Carpenter Rd <br />(Mailing Address) <br />Modesto, CA 95351 <br />(City, State, Ζίp 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 />ΑΡΝ <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />ΤΥΡΕ <br />FORMS <br />NOTES <br />OFFICE USE ONL Υ <br />13otJ5J.-4 REF# <br />CR# <br />1Zs-t rHJ aι;cJμ 1 =ο <J}ι~?2ό <br />IJ.o-e.lJ. ~ AJE. • <br />9Τgι:,ι~~Ι,.) QUAD ~s <br />Αι;ΙJ.JΑ ι.. ωcι.ιι.. <br />~w <br />~'"';5pk,;AL, ~,Jl)ΠJbiJ& ,, <br />DR IVEWAYS : <br />* <br />* <br />* <br />Crew to call SJ County lnspector at (209) 953 -7 42 1 48 to 72 hou rs before wo rk starts . <br />When calling, crew shall request "rain clearance" for any work durίng wίnter months <br />November through March <br />Th e undersigned hereby appl ies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br />the South side of Hobart Ave appro ximately 120' ee mile East <br />of S Wall<er Ln Stocl <ton , by performing the fo llowing work ( escription of work): <br />LOC 1 -Replace overhead on existing pole to 308 S Walker Ln & install transformer <br />LOC 2-open secondary on existing pole <br />**ΑΙΙ overhead worl< <br />Work will commence on or after ____ 3~/_2_5~/2_0_-_0_9~/5~/_2_0 ___ for appro ximately --~6~m~o~n=th~s ___ days. <br />1, th e 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 ίn accordance with the rules and regulations of San Joaquin County and subject to iπspection aπd approval . <br />w~r · <br />Signature of AppΞue 2/26/20 <br />Date <br />Y:IFORMS & TEMPLATESIENCROACHMENT ΡΕRΜΙΤ APPLICATION.doc (08108)