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APPLICATION 1=0R ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 5/14/2018 OFFICE USE ONLY <br /> To: San Joaquin County JOB ik REF i/ <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> t <br /> PG&E PM 3�;i 2;iO VALID TO DRIVEWAYS: <br /> (Applicant Name) I STREET <br /> 4040 West Lane AREA QUAD <br /> 1 YPE <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(a pge.com <br /> (Email Address) <br /> Sketch (Detailed plans may be submitted) <br /> Crew to call SJ County Inspector at (209) 053-7421 48 to 72 hours before work starts, <br /> When calling, crew shall request"rain clearance" for any work during winter months <br /> November through Marcll <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way <br /> on the WEST side of F st.approximately 70'SOUTI-I of Waterloo Rd, <br /> by performing the following work(description of work): <br /> Installation of new deep well anode, rectifier, anode and cathode wires and G5 frame and covers <br /> Deactivation of existing deep well - after deactivation, backfill will be to County R-29 Ie luirements <br /> wail t'vill(;()uu1w11o!unorolh!l /1/.'0I'1;___ Ilu ;ilq)illxinr)Il�ly I,iy:, <br /> I, the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to(lo the <br /> work described above in accordance with th rules and regulations of San Joaquin County and subject to inspection and approval, <br /> 5/'14/2018 <br /> ignature of Applicant-Title Date <br /> Y.W010I3A]E11P1AIESIEIICROACIO.Vir PERU APPL(CA110114n(031ja) <br />