Laserfiche WebLink
%e � i `V fr. D <br />APPLICATION FOR ENCROACHMENT PERMIT PI U Ii C 0 U N i' <br />PLEASE PRINT: <br />Date 10/8/19 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35105531 <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 />WAT8@ PGE.COM <br />(Email Address) <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 East side of N Alpine Rd approximately 137' ee mile North <br />of Orford RdStockton by performing the following work ( escription of work): <br />Install fuse on existing pole. All overhead work <br />Work will commence on or after 12/10/19 - 05/20/20 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 />Signature of Applicant •Title <br />Y:IFORMS & TEMPLATESIENCRCACHMEM PERMIT APPLICATICN.dw (08108) <br />10/8/19 <br />Date <br />OFFICE USE.ONLY r U I i ,; ;y r ;• f. <br />JOB # <br />75405 Z- REF # <br />APN <br />CR # <br />EXP. DATE <br />12o <br />VALID <br />2 a 9 1 G Zo DRIVEWAYS: <br />STREET <br />06 <br />AREA <br />ack7vrJ QUAD ME <br />TYPE <br />1 A k 49NI <br />FORMS <br />t.✓tl <br />NOTES <br />S C✓.4 z e.04DrvbADS <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 East side of N Alpine Rd approximately 137' ee mile North <br />of Orford RdStockton by performing the following work ( escription of work): <br />Install fuse on existing pole. All overhead work <br />Work will commence on or after 12/10/19 - 05/20/20 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 />Signature of Applicant •Title <br />Y:IFORMS & TEMPLATESIENCRCACHMEM PERMIT APPLICATICN.dw (08108) <br />10/8/19 <br />Date <br />