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APPLICATION FOR ENCROACHMENT PERMIT PG&E PM # 31170483 <br /> PLEASE PRINT: <br /> Date 17 —zy IS- OFFICE USE ONLY <br /> To: San Joaquin County JOB# ;'� REF# <br /> Department of Public Works APN CR# <br /> Pacific Gas & Electric Company (PG&E) EXP.DATE .7 S - <br /> VALID I -1 h - 5 TO __! 6 DRIVEWAYS: <br /> (Applicant Name) STREET SSC_44 �o't ae� cjof <br /> pp AREA E,6a fly— QUAD S <br /> W e'L+ L-aAe- TYPE 3,02—e <br /> (Mailing Address) FORMS S� > y <br /> NOTES <br /> (City,State,Zip Code) <br /> 209- 3 7_3 q q 3 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Please refer to attached construction drawing & Traffic Plan <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the West side of Escalon Bellota Rd approximately 0.3 fleet/mile North <br /> of Frlwnrds Rri in the , Esc2lon arpn , by performing the following work(description of work): <br /> Work on shoulder to install pole & transformer overhead. <br /> Work will commence on or about I ! —2 b l for approximately 0 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 tl�e rules and regulations of San Joaquin County and subject to inspection and approval. <br /> 1-7 <br /> Signature of Applicant-Title Date <br /> Mark O. Hughes - Sr. Engineering Estimator, PG&E <br /> M:10ENTRALSERVICESICLERICALIPUB-SV.WKWASTER.PSIENCROACHMENTPERMRAPPLICATION.DOC (09111) <br />