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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date IU/ <br />9/19 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35103215 <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 />?.D1901CT -J PM I* 03 <br />JOB # <br />APN <br />EXP, DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE <br />73006d _ <br />4 is �a <br />lolzeAlq 9 To <br />SARC-=Eor fes. <br />I.D> QUAD <br />ER M9L OKk <br />A56 <br />" <br />ONLY' <br />REF # <br />CR # <br />rS DRIVEWAYS: <br />uE <br />ok7 <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 South side of E Sargent Rd approximately 213' ee mile East <br />of N Tully Rd Lodi by performing the following work( escription of work); <br />Replace overhead switch. All overhead work <br />Work will commence on or after 10/28/19 - 04/15/20 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 />EVOWEa <br />Signature of <br />cant -Title <br />Y:IFORMS & TEMPLATESIENCROACHMENT PERMIT APPLICATICN.doc (08108) <br />10/9/19 <br />Date <br />