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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 12/5/19 <br />To; San Joaquin County <br />Department of Public Works <br />PG&E PM 31453307 <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 />WAT8C@PGE.00M <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />JOB # <br />APN <br />EXP. DATE/s' <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730D.4o A REF # <br />CR # <br />zo <br />! 24 to h DRIVEWAYS: <br />1A)iMea. P13, <br />bQUAD <br />444 AL IA%a¢46e, <br />'65/,,,/,,I <br />�19G PMAbK)S " <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 West/East side of N Wimer Rd approximately 700' ee mile South <br />of HWY 26 Linden by performing the following work ( escription of work): <br />Install transformer on existing pole and replace overhead service wire. *All overhead work <br />Work will commence on or after 1/15/20 - 07/15/20 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:IFORMS & TEMPLATESIENCROACHMENT PERMIT APPLICATICN.dac <br />12/5/19 <br />Date <br />