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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date <br />8/7/19 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 350584.06 <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 />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 />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 Virginia Ln approximately 481'ee mile South <br />of Country Club Blvd Stockton , by performing the following work (escription of work): <br />Pole replacement; pole in backyard <br />Work will commence on or after 8/29/19 - 12/31/19 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 />Signature of App scant - Title <br />Y9PORMS 8 TEMPLATESIENCROACHMENT PERMIT APPLICATION.doc (08/08) <br />8/7/19 <br />Date <br />OFFICE USE ONLY <br />JOB # 7-Aw ad 4 REF # <br />APN CR # <br />EXP. DATE 1,X0 <br />VALID 0 41, 2® DRIVEWAYS: <br />STREET a aL& <br />AREA QUAD <br />TYPE FolzReplacemf-4 <br />FORMS 1W <br />NOTES <br />C Ices <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 />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 Virginia Ln approximately 481'ee mile South <br />of Country Club Blvd Stockton , by performing the following work (escription of work): <br />Pole replacement; pole in backyard <br />Work will commence on or after 8/29/19 - 12/31/19 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 />Signature of App scant - Title <br />Y9PORMS 8 TEMPLATESIENCROACHMENT PERMIT APPLICATION.doc (08/08) <br />8/7/19 <br />Date