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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 5/14/2018 <br />To: San Joaquin County <br />Department of Public Works <br />PG&E PM ;`)'137;1V)(, <br />(Applicant Name) <br />4040 West Lane <br />(Mailing Address) <br />Stockton I CA 95204 <br />(City, State, Zip Code) <br />('209) 470 - 2300 <br />(Area Code - Telephone Number) <br />s6pzppge.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />OFFICE USE ONLY <br />JOB tt REF tt <br />APN CR It <br />EXP, DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <br />Crew to call SJ County Inspector at (209) 958-71!.21 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 the WEST side of F st. approximately --10' SOUTH 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 />■!� - • ilii • i • �e'i�ilT[igut► - I�iitit�Tl. • ililC•liwi�ilCiilll�llll� - • • e �s - ri <br />W(Ilk will (,()I III nu ur;(IlnI 11/ 11i4l;_ _ iu( ;pp>r(lxillwlnly d;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 do 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.70NAS 81 ELI PLAT ES¢IICAGACI]MENT PC (WIT APPCICATIOHdh (03tla( <br />