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t�LEASE PRINT: <br />Date <br />10/21/19 <br />Af'f'L-ICAI IUfJ 1=UK I"NCMACI°IIVILN I t'i RMl'i <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35114616 <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 maybe suhmiifed) <br />Crew to call SJ County Inspector at (209) 953-721 4� to 72 hours before work starts. <br />When calling, clew 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 HightivayRight-of-Way on <br />the East side of N Cherokee Ln approximately 1771' ee mile North <br />of Collier Rd Gait by performing the following work ( escription of work): <br />LOC 1 -Remove existing anchor and overhead wire service Added Scope- remove pole at LOC 6 &install <br />LOC 2 -Replace same size Pole, set in same hole Overhead service and meter at LOC 2 <br />LOC 3 - Replace overhead service <br />Work will commence on or after <br />for approximately <br />days. <br />I; the undersigned, certify that I an the owner bf ifie respective properly, or am qualified to represent the owner and agree io do the <br />work described above in accordance with the rules and regulations of San Joaquin County and subject to inspectionand approval, <br />Signature of Applicant •Title <br />Y.tiF03:!3 8 TEI rLV ES'FJ;CiQdHI VfT FfRISi FFFUCAl70!L6r, <br />10/?_1/19 <br />Date <br />OFFICE USE ONLY <br />013# <br />'.�06a 1( REF # <br />APN <br />CR # <br />EXP, DATE <br />15 ?-v <br />VALID <br />rr TO W � DRIVEWAYS: <br />STREET <br />CAG RoUJ4 <br />AREA <br />(02Iq QUAD ME <br />TYPE <br />FORMS <br />NOTES <br />Tows kf&w62 9XA1 Mi, 4eatAi. <br />Crew to call SJ County Inspector at (209) 953-721 4� to 72 hours before work starts. <br />When calling, clew 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 HightivayRight-of-Way on <br />the East side of N Cherokee Ln approximately 1771' ee mile North <br />of Collier Rd Gait by performing the following work ( escription of work): <br />LOC 1 -Remove existing anchor and overhead wire service Added Scope- remove pole at LOC 6 &install <br />LOC 2 -Replace same size Pole, set in same hole Overhead service and meter at LOC 2 <br />LOC 3 - Replace overhead service <br />Work will commence on or after <br />for approximately <br />days. <br />I; the undersigned, certify that I an the owner bf ifie respective properly, or am qualified to represent the owner and agree io do the <br />work described above in accordance with the rules and regulations of San Joaquin County and subject to inspectionand approval, <br />Signature of Applicant •Title <br />Y.tiF03:!3 8 TEI rLV ES'FJ;CiQdHI VfT FfRISi FFFUCAl70!L6r, <br />10/?_1/19 <br />Date <br />