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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> 2- TO <br /> Pacific Gas and Electric Co. VALID 3 DRIVEWAYS: <br /> 2KP.O. Box 930 STREET — <br /> AREA QUAD <br /> Stockton, CA 95201 TYPE 'BE�4- hle,LJC- <br /> FORMS P--2- <br /> NOTES <br /> -NU I ES <br /> -(Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> Sketch <br /> attached sketch. Shall be as per <br /> P MM <br /> P -7 <br /> current M.11-1,T.C.D. <br /> Notif. <br /> California supplement. <br /> The undersignedhereby applies for permission to excavate, construct and/or otherwise encroach 9n Counp Highway Right-of-Way on <br /> the �':L6 side of <br /> of approximately fee ile <br /> < <br /> by performing the following work Pscription of work): <br /> 0 <br /> 7 77� <br /> Work will commence on or about <br /> C for approximately <br /> days. <br /> 1,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 7 <br /> Date <br /> TUBK'�RMITAP-L;CA'IGN DOC pwoa) <br />