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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 6/19/2018 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 31209286 <br />(Applicant Name) <br />4040 West Lane <br />(Mailing Address) <br />Stockton, CA 95204 <br />(City, State, Zip Code) <br />(209) 470 - 2300 <br />(Area Code -Telephone Number) <br />s6pz @,pge.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE/�dCcme► <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />rJ3CX1$ra-CP REF # <br />CR # <br />I 11�1 l <br />%�? T6 DRIVEWAYS: <br />�f t�FtlE <br />QUAD 58 <br />Crew to call SJ County Inspector at (209) 953-7421 4� 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 <br />on Nile Ave from S Airport Way to S Union Rd, <br />by performing the following work (description of work): <br />28 Locations: Replace 15 poles, Install 2 new poles, Replace overhead conductor, remove old anchors and span guys <br />Work will commence on or after <br />/20/2018 for approximately 180 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 />6/19/2018 <br />Signature of Applicant -Title Date <br />YaPORMS & TEMPLATESIENCROACHMEN7 PERMIT APPLICATION.dac (08/08) <br />