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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 7/30/2018 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 'j 00 �� REF# <br /> Department of Public Works APN CR# <br /> XP <br /> PG&E PM 31393244 VALIDDATE TO DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA QUAD <br /> 4040 West Lane TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> Stockton, CA 95204 <br /> (City, State, Zip Code) <br /> (209) 470 - 2300 <br /> (Area Code-Telephone Number) <br /> s6pz@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 and/or otherwise encroach on County Highway Right-of-Way <br /> on Anthony Ave apprxomately 90' SOUTH of Hobart Ave, <br /> by performing the following work(description of work): <br /> Installation of deep well anode, ground rod, pole mount rectifier <br /> Work will commence on or after _ _-_ 1010,112018 for approximately - _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 /> 7/30/2018 <br /> Signature of Applicant-Title Date <br /> YMORMS 8 TEI.IPLATESENCROACHI,IENT PERMIT APKICAT ION Ox(OW8) <br />