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P,PPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10/22/19 <br />To: Cl"SJoaquin County <br />Department of Public Works <br />PG&E PM 35 V � <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 />REF # <br />CR # <br />TO DRIVEWAYS: <br />QUAD <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 Oakwilde Ave approximately 277 ee mile South <br />of Las Positas Circle Stockton by performing the following work (escription of work): <br />Maintenance work in existing electric box. no ground disturbance will take place <br />Work will commence on or after <br />for approximately <br />6 months <br />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 Ap <br />nt -Title <br />Y:IPCRMS 8 TEtdPlATE51ENCR0ACHMENT PERMIT APPl1CATI0N.dac (Ofl�08) <br />10/22/19 <br />