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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date <br />2/7/20 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35047339 <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 />JOB# <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />OFFICE USE ONLY <br />JSa_4 REF# <br />CR # <br />1 <br />I TO q / DRIVEWAYS: <br />WaNy 11a i zzl /44 D,R. <br />AREA <br />TYPE <br />Sroek Z0 QUAD <br />A40 AIM AOUA4 <br />$bJ <br />lAa #JAek- , <br />FORMS <br />NOTES <br />!%Avw A29 <br />�° `ji@Ljt1G 46A-WIT-aAnti <br />Sketch (Detailed plans may be submitted) <br />Crew to call SJ County Inspector at (209) 953-7421 48 to 72 hours before work starts. <br />When calling, crew shall request "rain clearance" for any work during winter months <br />November through March <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the side of Manthey Rd & 5 Leo Giron Dr approximately ee mile <br />Of French Camp , by performing the following work dption of work): <br />remove poles, remove <br />Work will commence on or after 2/25/20 - 08/25/20 for approximately 6 months days. <br />I, the undersigned, certify that I am the owner of the respective property, or am qualified to represent the owner and agree to do the <br />work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />Signature of App rcant - Title <br />YMORMS d TRIP01EMNCROnHMENl PEW PPPLICRTION� (UM"$) <br />2/7/20 <br />Date <br />