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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date /n / OFFICE USE ONLY <br /> To: San Joaquin County JOB # REF # <br /> Department of'Public Works APN _ CR # <br /> _ <br /> C, LSI b&- EXP. DATE <br /> Ray MacClanahan-- M-3 Construction <br /> VALID d TO DRIVEWAYS s <br /> (Applicant Name) STREET <br /> 1501 Long Gate Road AREAG�� QUAD -'�— <br /> TYPE -IA& .;C.+ <br /> (Mailing Address) FORMS <br /> Plymouth, CA 95669 NOTE <br /> (City, St to, Zip Code) <br /> 2095254 <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> See attached Traffic Control Plan&Drawing C3 of the Improvements Plan <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the East side of <br /> North Thornton Road approximately 500 feet mile North <br /> of Highway 12 <br /> byper€orming the <br /> following work (description of work) : Trench 8 feet bgs into existing sanitary sewer manhole on <br /> Thornton Road as shown on C3 <br /> Work will commence on or about 20 d for approximately <br /> 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 rules, regulations of San Joaquin County and subject to <br /> inspection and appro 1. <br /> /1 <br /> Signa a of Applicant - Title Date <br /> MASTEE.PS\NE8SCHDL (6/00) <br />