Laserfiche WebLink
PLEASE PRINT; <br />To <br />APPLICATION FOR ENCROACHMENT PERMIT <br />12/11/19 <br />San Joaquin County <br />Department of Public Works <br />• <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 />'�j(j g�o1-4 REF # <br />CR # <br />g 20 <br />5 2O 120 DRIVEWAYS: <br />t4Ck6 jAeD. <br />_ir4Cb QUAD A?9 <br />Q, ,i4 L b kwi <br />k% <br />S qL <br />Crew to call SJ County Inspector at (209) 953-7421 4� to �i� 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 North side of Locl<e Rd approximately 29' ee mile West <br />of Jack Tone Rd Lockeford by performing the following work ( escription of work): <br />Install transformer on existing pole. "All <br />overhead work <br />Work will commence on or after 1/15/20 - 07/25/20 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 <br />cant -Title <br />Y:IFORMS & TEMPLATESIENCROACHMEPIT PERMIT APPLICATIOPI.doc <br />12/11/19 <br />Date <br />