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PLEASE PRINT: <br />Date 2/2s/2o2o <br />APPLICATION FOR ENCROACHMEN`I" PERIVII I <br />To: San Joaquin County <br />Department of Public Works <br />PGE PM 35148830 <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.00M <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 />%;%�iZ.%� REF # <br />CR # <br />�' ,'!O TO / oho DRIVEWAYS: <br />,47Z;ek XI)0 <br />j40gA/ QUAD <br />JA&044 G0 <br />5S k/b✓ <br />"Sp14L GD7t>t�I� ' <br />Crew to call SJ County Inspector afi (209) 953-7421 48 fio 72 hours before work starts. <br />When calling, crew shall request "rain clearance" for any wor{< 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 Noun side of Comstock RD approximately ass feet/mile west <br />Of Duncan RD Linden by perfgrming the following work (description of work): <br />t5okw <br />iTGy <br />Work will commence on or after si2sizozo - s/zs/zozo <br />for approximately s months <br />=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 />Signature of Appl�ant •Title <br />Y:IFCRMS & TEMPLATESIENCRDACHMENT PERMR' APPLICATICN.dac (08108) <br />2/26/2020 <br />Date <br />