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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/5/20 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35150523 <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 />73;0$d-4,4 REF # <br />a I CR # <br />9/s`.a0 <br />3 zo 2b to 4 fs` ?v <br />�k/E <br />QUAD �$ <br />�'t-LL 14bLe <br />5'S/ww. ,�-ZS 'T12EIJCH C4*rm <br />qG dna r ,4>S <br />DRIVEWAYS: <br />At/ ey <br />Crew to call SJ County Inspector at (209) 953m7�!?1 �� to 72 hours before work starts. <br />When calling, crew shall request "rain clearance" for any work during winter months <br />November through Larch <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the East side of S Olive Ave approximately 380' ee mile South <br />of E 6th St Stockton by performing the following work ( escription of work): <br />Restore pavement after emerg <br />ency has leak <br />Work will commence on or after 3/10/20 - 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 />3/5/20 <br />Signature of Applicant •Title Dace <br />Y:IFCRMS 8 TEMPLATESIENCRCACHMENT PERMIT APPLICATICN.doc (00100) <br />