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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT::, <br />To; <br />San Joaquin County <br />Department of Public Works <br />PG&E PM 35057370 <br />(Applicant Name) <br />1524 N Carpenter Rd <br />(Mailing Address) <br />Modesto, CA 95351 <br />(City, State, Zip Code) <br />20M57-0181 <br />(Area Code •Telephone Number) <br />WAT8@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 />TYPEIELL1{OLE�,4 <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />�73oasa - 4 REF # <br />CR # <br />20 TO / 20 <br />nd 9f TAI c.A h7-cti <br />QUAD E'S <br />h/ 9- �A�f� C��'l <br />e0A)V1wnR <br />DRIVEWAYS: <br />�oG)c!0" <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 andlor otherwise encroach on County Highway Right -of -Way on <br />the side of BASIN ST & TALLAHATCHEY DR approximately ee mile <br />of Stockton , by performing the following work (description of work): <br />REPLACE 3,580 FT OF EXISTING DISTRIBUTION MAIN. INSTALL 3,600 FT OF NEW DISTRIBUTION MAIN. <br />Work will commence on or after <br />20 <br />for approximately b montns uays, <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 & TEMPLATESIENCROACHMENT PERMIT APPLICATION.doc (OBI08) <br />9/30/19 <br />Date <br />