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E:CEIV- D <br />JO"tJt.IN COUN1 Y <br />APPLICATION FOR ENCROACHMENT PERMT j10V 15 PPS i: 53 <br />PLEASE PRINT: <br />Date 11/15/19 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 31461375 <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 />7300fa-4 REF # <br />CR # <br />(Z �1 jj 'TO 57116*1 2w DRIVEWAYS: <br />Mipgts4 ,b <br />arjaG{C,C j QUAD <br />kickop. R. rLAee&64r <br />A/ <br />; 8roC <br />Crew to call SJ County Inspector at (��9) 953-741 �!�� to '�� hour�� (�����iG'ti� work starts. <br />When calling, crew shall request "rain clearance" for any work during winter months <br />November through VLio <br />;uu <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the West side of Mobley Rd approximately 4,493' ee mile North <br />of Gawne Rd Stockton , by performing the following work ( escription of work); <br />Anchor replacement <br />Work will commence on or after 12/29/19 - 05/10/20 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 />cant -Title <br />Y:IFCRMS 8 TEMPLATESIENCRCACNMENT PERMIT APPLICATICN.doa (08108) <br />11/15/19 <br />Date <br />