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PLEASE.PRIN I <br />To; <br />The <br />the , <br />of <br />undersigned hereby applies for permission fo excavate, construct antl/or otherwise encroach on County Highway Right -of --Way on <br />�our�a side of Yu,¢�v�c,� ��r approximately 80® ee mile t✓A57' <br />er cF n4y/s Woo , by performing the following work (de cripilon of work): <br />EC <br />APPLICATION FOR ENCROACHMENT PERMIT <br />10-30-19 <br />all Joaquin. County <br />Department of Public Works <br />PG&E <br />(Applicant Name) <br />4155 E Childs Ave <br />(Mailing Address) <br />Merced, CA, 95340 <br />(Cify, State, Zip Code) <br />408-605-6657 <br />(Area Code • Telephone Number) <br />DQHN@PGE.COM <br />(Email Address) <br />Sketch (petalled 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 />73g:�oSA REF # <br />CR # <br />1112srfil fo / 20 DRIVEWAYS. <br />i 141wer? gV e <br />Lo,a / QUAD A11A) ` <br />V&Sl.t� HOL4 ,�v Di2TS,�/vu�D � <br />ss W ,e Z^7 <br />� 5,4euo4 L NDrr)pliS ' <br />D /905&?e:0r ezrr <br />Crew to call SJ County Inspector at (209) 953-7421 48 to i2 hours before work starts. <br />When calling, crew shall request "rain clearance" for any work during winter months <br />November through March <br />DA <br />D <br />Work will commence on or after <br />for approximately <br />days. <br />I, the undersigned, certify that I am the owner of the respective properly, or am qualified to represent the ownerantl agree to do the <br />work described above in accordance wish the rules and regulations of San Joaquin County and subject to inspection antl approval. <br />azzyxe-,�IaV]�6Lzo <br />Permit Facilitator <br />Signature of App cant • Tltle <br />Y.1FORlli d TEIrAATESfI;fROnO"l'EIT PERVR RP?11C.4T10.`! du (CL{o) <br />10/30/19 <br />Date. <br />