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RECEI' D <br />APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: 2019 MMV 1:3 PM 1' 53 <br />Date 11/15/19 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 43818392 <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 />OFFI..EUS <br />'130p�a-� <br />(o 7A <br />i Tb <br />RD . <br />cAm QUAD <br />AL—W4AL <br />NL'Y"` <br />REF # <br />CR # <br />DRIVEWAYS: <br />Atyj <br />i <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 Peltier Rd approximately 240' ee mile West <br />of Des Moines Rd Acampo by performing the following work ( escription of work): <br />Board replacement on existing sole.*ALL OVERHEAD WORK <br />Work will commence on or after 12/25/19 - 06/5/20 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 & TEMPLATE5IENGROACNMENT PERMIT APPIICATICN.dac (08108) <br />11/15/19 <br />Date <br />