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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 9/6/19 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35091087 <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 />WATS@PGE.COM <br />(Email Address) <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREETF <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />REF # <br />CR # <br />41112-c <br />tolls -jig O .411 12.0 DRIVEWAYS: <br />Qf-tgma td. <br />Slack--mri QUAD Apt <br />-Ptll-6 teEPLgCG-ME AY <br />!g�kJ <br />" 5PEcl,rat, e_&0ZCnb0S" <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 North side of E Foppiano Ln approximately 7421 ee mile East <br />of Oneto Rd Stockton , by performing the following work (escriptlon of work): <br />Pole replacement <br />Work will commence on or after 10/15/19 - 03/25/20 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 />Gr% � - <br />Signature of App (cant -Title <br />Y:IFGWS LTPIPIATEMMOKHMTP 917P UaTIONax(Q ) <br />9/6/19 <br />Date <br />