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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10/21/19 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM 35115713 <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 />STREET <br />AREA <br />TYPEl'tnN <br />FORMS <br />NOTES <br />7360 sodA <br />17 - <br />ca <br />"S <br />OFFICE USE ONLY <br />�% REF # <br />CR # <br />a,o <br />Th (o ¢o DRIVEWAYS: <br />rcrAt <br />QUAD ME <br />Coad. lDAJ ` <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 />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the North side of E Jahant Rd approximately 460' ee mile East <br />of N Graham Rd Acampo by performing the following work ( escription of work): <br />Reframe existing pole install transformer, replace overhead wire <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:IFCRMS 8 TEMPLAiE51ENCR0ACHMENT PERMIT APPLICATION.dac <br />10/21/19 <br />Date <br />