Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10/31/19 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35122727 <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 />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />9&)o S'd _ 4 REF # <br />CR # <br />6oto . <br />11zS 14 TO Zo DRIVEWAYS: <br />9D. <br />Loral QUAD AltJ <br />rSa REPLACC&V kri+ 4 A eP4 A L U &U2 <br />ss/WPI <br />4SCapLi� <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 Ray Rd approximately 1179ee mile South <br />of W Kile Rd Lodi by performing the following work ( escription of work): <br />Replace pole 35' North of existing pole, install transformers in new pole. Replace overhead service on new pole <br />being installed in private property <br />Work will commence on or after 11/5/19 - 05/25/20 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 & TEMPLATESIENCROACHMENT PERMIT APPLICATI ON.doc (OBIOB) <br />10/31/19 <br />Date <br />