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Date 11-26-2019 <br />To: San Joaquin County <br />Department of Public Works <br />PGE PM 31418885 <br />(Applicant Name) <br />3136 Boeing <br />(Mailing Address) <br />Stockton. CA 95206 <br />APPLICATION FOR ENCROACHMENT PERMIT <br />(City, State, Zip Code) <br />(209) 210-0454 <br />(Area Code - Telephone Number) <br />T8M3@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 />7900 Sol REF # <br />CR # <br />4 0 10/1 5m 72,v DRIVEWAYS: <br />NAQNE� Gtl <br />Loaf QUAD Nj5 <br />?oIGE ,t'6PGs+C�•K�+�' <br />Ss/tom«/ <br />"�S rvL edNnrno.A.)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 />Structure 004/093 <br />AppNx. q �t C� <br />rorr edq�c o� Ro <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the Noun side of E Harney Ln approximately 1,425 feet/mile East <br />Of Wlls Ln Stockton, ca by performing the following work (description of work): <br />Pole Replacement <br />Work will commence on or after s-4-2o2o <br />for approximately ? <br />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 />TW Ma?�k <br />in�z <br />Signature of Applicant � Title <br />Y:IFORMS & TEMPLATE8IENCROACHMENT PERMIT APPLICATICN.doc (08108) <br />11-26-2019 <br />