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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10/18/19 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM _31475483 <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 />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 East side of Del Mar Ave approximately 151' ee mile South <br />of Dana Ave Stockton by performing the following work ( escription of work): <br />replace overhead cross arm on existing pole All overhead work <br />**emergency work already done,_ permit submitted after the fact Wei <br />Work will commence on or after <br />19 for approximately <br />nays. <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 TEMPLATESIENCROACHMENT PERMIT APPUCATICN.dw (OBI08) <br />10/18/19 <br />Date <br />OFFICE USE <br />ONLY <br />JOB # <br />7�gp�p� - 9 <br />REF # <br />APN <br />CR # <br />EXP. DATE <br />VALID <br />lZ 1 f <br />/ /9 f TO 12 <br />7, 119 DRIVEWAYS: <br />STREET <br />,rlehi1 4ygb <br />AREA <br />QUAD <br />455 <br />TYPE <br />FORMS <br />NOTES <br />Al G <br />C[2 <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 East side of Del Mar Ave approximately 151' ee mile South <br />of Dana Ave Stockton by performing the following work ( escription of work): <br />replace overhead cross arm on existing pole All overhead work <br />**emergency work already done,_ permit submitted after the fact Wei <br />Work will commence on or after <br />19 for approximately <br />nays. <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 TEMPLATESIENCROACHMENT PERMIT APPUCATICN.dw (OBI08) <br />10/18/19 <br />Date <br />