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PLEASE PRINT: <br />Date 2/28/2020 <br />To; San Joaquin County <br />Department of Public Works <br />PGE PM 31482736 <br />(Applicant Name) <br />1524 N Carpenter Rd <br />(Mailing Address) <br />Modesto, CA 95351 <br />(City, State, Zip Code) <br />857-0181 <br />(Area Code - Telephone Number) <br />WATS(a). <br />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 />�%3u0$�2-LJ REF # <br />CR # <br />'f i-0 <br />a TO DRIVEWAYS: <br />$?a46reA/ QUAD N& <br />,Q,�qL IZA&W4 <br />55 /,✓�,i <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 />Cam <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the Southeast side of Alpine Road approximately 600 feet/mile soutneast <br />Of summers Court Stockton , by performing the following work (description of work): <br />crossarm - No ground disturbance <br />Work will commence on or after sit zizozo - si12i2o2o for approximately s montns days. <br />1 Working Day <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 />Gt/Za� %c <br />Signature of Applicant -Title <br />Y:IFORMS 8 TEMPLATESIENCROACNMENi PERMIT APPLICATION.doc (00108) <br />2/28/2020 <br />Date <br />