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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 5/23/2018 <br />To: an Joaquin County <br />Department of Public Works <br />PG&E PM 31193591 <br />(Applicant Name) <br />4040 West Lane <br />(Mailing Address) <br />CA 95204 <br />(City, State, Zip Code) <br />(209) 470 - 2300 <br />(Area Code - Telephone Number) <br />s6pzRpge.com <br />(Email Address) <br />may <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP, DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <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 far permission to excavate, construct and/or otherwise encroach on County Highway Right -Of -Way <br />on the WEST side of Herndon PI, approximately 120' NORTH of Calhoun Way, <br />by performing the following work (description of work): <br />.. . . . .. , <br />Work will commence on or after for approximately 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 accorda e with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />. 5/23/2018 <br />Signature of Applicant - Title Date <br />Y:nFORMSLTFMFUTSIENMOAn MENTP�MI.ArPLIQTI xea SOWS) <br />