Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 1/31/23 <br />To: San Joaquin County <br />Department of Public Works <br />Pacific Gas & Electric- Candice Laccetri <br />(Applicant Name) <br />1524 N. Carpenter Rd <br />(Mailing Address) <br />Modesto, CA 95351 <br />(City, State, Zip Code) <br />(925) 303 9471 <br />(Area Code - Telephone Number) <br />C6L5@pge. com / STDivpgepennits@pge corn <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />PM 35343967 <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730052 REF # <br />CR # <br />3/3/2023 TO 0/1/2023 DRIVEWAYS: <br />Ellen St. <br />Stockton QUAD NS <br />Pole Replacement Aerial Work <br />SS/WW <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the wen — side of — — Ellen s_ _ _ _ approximately– 013— ®feet/ Qmile_ Penn <br />of E Fremont s< swcCon by performing the following work (description of work): <br />Traffic control to replace pole and pull cable for new UG service. <br />Work will commence on or after_ — — — 3/3/23 _ _ _ _ for approximately_ — 1eo---- days. <br />I, the undersigned, certitythat I am the owner of the respective property, oram qualified to representthe 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 />1/3123 <br />Signature of Applicant - Title <br />Date <br />