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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />To <br />11/12/19 <br />San Joaquin County <br />Department of Public Works <br />PG&C PM 35 ?304 <br />(Applicant Name) <br />1524 N CarpenterRd <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 />7'a0va .`t REF # <br />CR # <br />(a 4 t2-0 <br />V '3o 19 TO i1 3 e DRIVEWAYS: <br />Ael� , —� <br />QUAD G✓ <br />T /G �llAif�d� �✓eC�S <br />d <br />I%Aek Abs IZ04 P <br />Crew to call SJ County Inspector at (209) 9537421 �� to �2 hours ��fer� work starts. <br />When calling, crew shall request "rain clearance" for any work during winter months <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right -of -Way on <br />the Rear side of 2315 W Swain Rd approximately 300' ee mile West <br />of Swain D Ct Stockton by performing the following work ( escription of work): <br />Pole replacement with backyard machine <br />Work will commence on or after 12/30/19 - 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 <br />cant -Title <br />Y:IFCRMS & TEMPLATESIENCftCACHMENT PERMIT APPLICATION.doc (OBIOB) <br />11/12/19 <br />