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APPLICATION FOR ENCROACHMENT PERMIT. <br />PLEASE PRINT: <br />Date 10/23/19 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35123448 <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 />STREETj4�ie <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE <br />%051,4 <br />5' 2.0 <br />Il 2,Sftq 'Td S <br />c i opt 2D, <br />G1A11)HV QUAD <br />LE t,q4c <br />zWkI <br />ONLY <br />REF # <br />CR # <br />(S Lo DRIVEWAYS: <br />NE <br />, <br />D�tS <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 andlor otherwise encroach on County Highway Right -of -Way on <br />the North side of E Milton Rd approximately 1.50 fee mile West <br />of N Fine Rd Linden by performing the following work (descrip ion of work): <br />Pole <br />Work will commence on or after 11/25/19 - 05/2/20 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:IFCRMS & TEMPLATESIENCROACHMENT PERMIT APPLICATICN.doc <br />10/23/19 <br />Date <br />