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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 212612020 <br />Το : San Joaquin County <br />Department of Public Works <br />PGE ΡΜ 35131221 <br />(Applicant Name) <br />1524 Ν 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 .C OM <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 />1!,ι:)6~2.-4 REF # <br />CR# <br />'1/ι / ι,ο <br />~/v.,,/ ;,ο ' ι το 1/ι/;,6 <br />'Jl~M~tJ jά). ' , <br />Jl~M/0 QUAD ι/Ε <br />A~AL~<. <br />~ 11 SP6qAt., tAPJ.).J>ΠJD.i)t 1' <br />Crew to call SJ County lnspector 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 />DRIVEWAYS: <br />* <br />* <br />* <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br />the North side of Acampo RD approximately 1,330 feet/mile _w_es_t __ <br />of Ν Kennefick RD , Acampo , by performing the following work (description of work): <br />Replace Transformer (Overhead work, no ground disturbance) <br />Work will commence on or after 3/2612020 -6/26/2020 for approximately 3 months days . <br />11 working day 1 <br />1, the undersigned, certify that I am the owner of the respective property, or am qualified to represent the owner and agΓee 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 />WdbivvT · <br />Signature of App~e <br />2/26/2020 <br />Date <br />Y:IFORMS & TEMPLATESIENCRDACHMENT PERMIT ΛPPLICATION.doc (06/08) <br />/