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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 11/4/19 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35114619 <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 />7 3w6d-'� REF # <br />CR # <br />11474 <br />kL 50 14 to yrs zo DRIVEWAYS: <br />W1e Mr9R.1'H RD. <br />SwckTbM QUAD IvtE <br />ArmaiAL. Wokk <br />5S WN% <br />" 05PEGc wL &13Dr11b a <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 East/West side of Wilmart�Rd approximately 1 370' ee mile North <br />of Waterloo Rd Stockton by performing the following work ( escription of work): <br />Replace overhead service wire; all overhead work <br />Work will commence on or after 12/5/19 - 05/15/20 for approximately <br />• u�� SIT.` <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 <br />cant •Title <br />Y:IFCRMS 8 TEMPLATESIENCROACHMENT PERMIT APPLICATICN.dac <br />11/4/19 <br />Date <br />