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APPLICATION FOR ENCROACHMENT PERMIT <br />ME�01kow <br />Date 10/31/19 <br />To; San Joaquin County <br />Department of Public Works <br />runt PM 35129799 <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 />WATB@PGE.COM <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />013# <br />APN <br />EXP, DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />7,30pSd ^ q REF # <br />CR # <br />SIS 2a <br />122 ti Tb <br />ST, <br />QUAD F� <br />$F, L1. X01.6 <br />Ss wvN, A2 -Z4, l"X" cl r <br />5 GA L ' <br />DRIVEWAYS: <br />AoC'7 <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 Sonora St approximately 315 ee mile East <br />of S Walker Ln Stockton by performing the following work (cescription of work); <br />5x5 bellhole; trench for gas service <br />Work will commence on or after 11/15/19 - 05/15/20 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 />Signature of Applicant •Title <br />Y:IFCRMS 8 TEMPLATESIENCROACNMENT PERMIT APPLICATION.dw <br />10/31/19 <br />Date <br />