Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 11/18/19 <br />To; San Joaquin County <br />Department of Public Works <br />PG&E PM 35066231 <br />(Applicant Name) <br />1524 N Carpenter Rd <br />(Mailing Address) <br />Modesto, CA 95351 <br />(City, (Z <br />tate, 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 />73wo • 4 REF # <br />CR # <br />20 <br />j 110ft! TO 7 I :! DRIVEWAYS; <br />9sicr9toA1aA&,&d+ AD• <br />1*4* WA/ QUAD Ne <br />L <br />d <br />a di arts <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 Escalon Bellota Rd approximately 4,630' ee mile South <br />of Copperopolis Rd Linden by performing the following work ( escription of.work): <br />Pole replacement <br />Work will commence on or after 1/10/20 - 06/25/20 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 />Signature of <br />-Title <br />Y:IFORMS 8 TEMPLATESIENCROACHMENT PERMIT APPLICATION.dac (08108) <br />11/18/19 <br />Date <br />