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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10/9/19 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 31473982 <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 />s'.C,c.1y1 0 <br />7�►19(�� -9 Pik It 03 <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 />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the West side of 99 Frontage Rd approximately 80ee mile South <br />of Balsam Dr Morada by performing the following work ( escription of work): <br />Replace fuse/switch on existing pole. all overhead work <br />Work will commence on or after 10/25/19 - 4/1/20 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 />I IN <br />Signature of Applicant -Title <br />Y:IFORMS & TEMPIATESIENCROACHMENT PERMIT APPLICATICNdoc (08108) <br />10/9/19 <br />Date <br />OFFICE USE ONl Yf.';" ;^ ti L I i <br />JOB # <br />7g Z,, 4 REF # <br />APN <br />CR # <br />EXP. DATE <br />r,� 24 <br />VALID <br />101115111 Tb 15' Z6 DRIVEWAYS: <br />STREET <br />0'AGE Ri7 E <br />AREA <br />ctC,),y,J QUAD A4 <br />TYPE <br />A EQ„ q , Djbak 49&y1, / <br />FORMS <br />2@)(40LO <br />NOTES <br />41 gF340caj L. 40�WMrr15J3!! 5 <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 />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the West side of 99 Frontage Rd approximately 80ee mile South <br />of Balsam Dr Morada by performing the following work ( escription of work): <br />Replace fuse/switch on existing pole. all overhead work <br />Work will commence on or after 10/25/19 - 4/1/20 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 />I IN <br />Signature of Applicant -Title <br />Y:IFORMS & TEMPIATESIENCROACHMENT PERMIT APPLICATICNdoc (08108) <br />10/9/19 <br />Date <br />