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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10/28/19 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35065998 <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 />STREETu <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />73oc�sa - 4 REF # <br />t t CR # <br />jo1 1 120 <br />t2 19 to cot 1 I zz DRIVEWAYS: <br />ct d60 <br />STackTo#J QUAD Wg <br />A wj4aC2 �E MoJA L /QE.�1►q L Wo�lt <br />T <br />116 i L <br />Crew to call SJ County Inspector at (209) 953-7421 48 to 7"2 hours before work starfis. <br />When calling, crew shall request "rain clearance" for any work during winter months <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 Mourfield Ave approximately 44' ee mile South <br />of Downing Ave , Stockton by performing the following work ( escription of work): <br />Remove anchor and replace overhead service <br />Work will commence on or after 12/1/19 - 05/25/20 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 Appiicant •Title <br />Y:IFORMS 8 iEMPLATESIENCROACHMENT PERMIT APPLICATION.doc <br />10/28/19 <br />Date <br />