Laserfiche WebLink
APPLICATION F®R ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 11/12/19 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 43919898 <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 />SET <br />TRE <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />ADS�a�%REF # <br />CR # <br />(o <br />2 9 0 / ;LO DRIVEWAYS: <br />t <br />QUAD <br />2 <br />' <br />Crew to call SJ County Inspector at (209) 953-74?_� 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 andlor otherwise encroach on County Highway Right -of -Way on <br />the East side of Davis Rd approximately 18ee mile South <br />of Lucas Rd Lodi by performing the following work ( escription of work): <br />Install conduits and #5 box <br />Work will commence on or after 12/20/19 - 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 Applicant •Title <br />Y:IFORMA 8 TEMPLATE8IENCRCACHMENT PERMIT APPLICATION.daa (08108) <br />11/12/19 <br />Date <br />