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PJC' 03 05 02: 08p Valued Customer 209 468-9324 <br /> P- 3 <br /> APPLICATION FOR ENCROACMMNT PERMIT <br /> PLEASE PRINT: <br /> Date June 1, 2006 OF?=ca Usg ONLY <br /> To: San Joaquin County JOB # A00 REF # <br /> Department of Public Works APN 4- <br /> EXP. DATE <br /> Matt McCarty VALID to f TO `1/ U DRIVEWAYS <br /> (Applicant Name) STREET <br /> AREA QUAD &W _ • <br /> 417 River Meadows Drive TYPE + <br /> (Mailing Address) roRMS <br /> NOTE <br /> Woodbridge, CA 95258 <br /> (City, State, Zip Code) <br /> 209-915-4805 <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plane may be submitted) <br /> See attached drawing. <br /> Maintain traffic controls for all roads. Two-way traffic shall be maintained <br /> during non-working hours with excavated areas backfilled or plated. During work <br /> hours, two-way traffic control shall be maintained with one lane ope�and <br /> appropriate flaggers. ALL 4teftck&% 1n work drte� a.nel co»e3 o+k4e- 4I W'�; `" <br /> eonf.ul de✓•«s sko.l( be C_tea i4cl euf A.-Id ore. for �►o/�se/�M{/�',� dlrr.rl� z <br /> _ � z <br /> non-warkr� lwvis, t�Ju�Se. P/br•oLtc�as-6u%� C�rlt,w��tgs, o � opt <br /> >M <br /> C _ C T�; <br /> The undersigned hereby applies for permission to excavate, construct dad/" <br /> otherwise encroach on County Highway Right-of-Way on the North/ ou NPsicle oft <br /> Augusta St.@ Orange St. a roxim�ar.al <br /> pp y 0 _ feet/mile x � <br /> of by per8Wdrming the <br /> following work (description of work) : Install a storm drain line to an' <br /> existing catch basin. Backfill and patch asphalt concrete as necessary._ <br /> Work will commence on or about June 5, 2006 for approximately <br /> 2 days. <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rulao, regulatinns of San Joactuin County and subject to <br /> inspection and approval. <br /> ";010-Z_'el <br /> -- , <br /> s ature of Applicant .. Title Date <br /> K&MR_B "2350ML 16/00) <br />