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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/12/2019 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35042899 <br />Applicant Name) <br />4040 West Lane <br />Mailing Address) <br />Stockton, CA 95204 <br />City, State, Zip Code) <br />209) 470 - 2300 <br />Area Code - Telephone Number) <br />s6pz(@,pqe.com <br />Email Address) <br />Detailed plans may be submitted) <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />7 <br />OFFICE USE ONLY <br />S Z REF # <br />CR # <br />TO DRIVEWAYS: <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />QUAD <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 <br />on E Live Oak Rd approximately 1400' EAST of Orange St, <br />by performing the following work (description of work): <br />Pale work. PG&E to install orimary Dole riser and underground Drimary in aDnlicant installed conduit <br />NEW electric service to 14875 East Live Oak Rd <br />Work will commence on or after 3/01/2019 for approximately 90 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 />u 2/12/2019 <br />Itjgnalure of Applicant - Title Date <br />y"RNIS&TEMpAg SENGROACHMENTPERM(iAPPUCATIONdz(ORIOR)