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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To:San Joaquin County JOB #REF # <br />Department of Public Works APN CR # <br />EXP. DATE <br />VALID TO <br />DRIVEWAYS: <br />(Applicant Name)STREET * <br />AREA QUAD <br />* <br />TYPE * <br />(Mailing Address)FORMS <br />NOTES <br />(City, State, Zip Code) <br />(Area Code -Telephone Number) <br />(Email Address) <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 ___________________________________ approximately ___________________ feet/mile _________ <br />of _______________________________________, ____________________, by performing the following work (description of work): <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 accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />Signature of Applicant -Title Date <br />Y:\FORMS & TEMPLATES\ENCROACHMENT PERMIT APPLICATION.doc (08/08) <br />Sketch (Detailed plans may be submitted) <br />1524 N Carpenter Rd <br />Modesto, CA 95351 <br />209-857-0181 <br />(Area Code Telephone Number)(Area Code Telephone Number) <br />WAT8@PGE.COM <br />PM 35161969 <br />9/8/20 <br />9/8/20 <br />6 ________________________ days.________________________ days.months________________________ days.________________________ days.10/25/20 _____________________________ for approximately_____________________________ for approximately_____________________________ for approximately_____________________________ for approximately03/25/20_____________________________ for approximately_____________________________ for approximately <br />C/O the ______________ side of ___________________________________ approximately ___________________ feet/mile _________the ______________ side of ___________________________________ approximately ___________________ feet/mile _________River the ______________ side of ___________________________________ approximately ___________________ feet/mile _________the ______________ side of ___________________________________ approximately ___________________ feet/mile _________Meadows the ______________ side of ___________________________________ approximately ___________________ feet/mile _________the ______________ side of ___________________________________ approximately ___________________ feet/mile _________Dr the ______________ side of ___________________________________ approximately ___________________ feet/mile _________the ______________ side of ___________________________________ approximately ___________________ feet/mile _________& the ______________ side of ___________________________________ approximately ___________________ feet/mile _________the ______________ side of ___________________________________ approximately ___________________ feet/mile _________Fawn the ______________ side of ___________________________________ approximately ___________________ feet/mile _________the ______________ side of ___________________________________ approximately ___________________ feet/mile _________Drthe ______________ side of ___________________________________ approximately ___________________ feet/mile _________the ______________ side of ___________________________________ approximately ___________________ feet/mile _________Woodbridge, ____________________, , ____________________, <br />replace enclosure rotten