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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10/31/19 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35129860 <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 />73oa57 REF # <br />CR # <br />S 20 <br />// 22 TO T11 20 <br />&)e)2ArrS► ,. <br />STdck7Z+•1 QUAD F'S <br />Wt& Nva 7i�NGH <br />s�/w,wo� %r"& fW Cur <br />DRIVEWAYS: <br />4tee y <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 475 ee mile East <br />of S Walker Ln Stockton by performing the following work ( escription of work): <br />5x5 hellhole, trench for gas service <br />Work will commence ori or after 11/4/19 - 04/25/20 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 />0 IN <br />Signature of Applicant •Title <br />Y:IFORMS 8 TEMPLATESIENCROACHMENT PERMIT APPLICATION.doo (OBI08J <br />10/31/19 <br />Date <br />