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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date July 5. 2007 OFFICE USE ONLY <br /> To: San Joaquin County JOB # y REF # <br /> Department of Public Works APN CR # <br /> Zabih Zaca EXP. DATE <br /> VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET <br /> 520 Tracy Blvd. AREA QUAD ;m <br /> TYPE _' r k-frrrJ L e0t,0 1 _ <br /> (Mailing Address) FORMS^J.,Tracy, CA CA 95376 NOTE <br /> (City, State, Zip Code) <br /> 209-831-4445 <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Detailed plans and specifications are submitted. <br /> fi%'fiF FI T cN/c'L Lr�i lc%;nJ .ALG /Ve,7K .4;2;.T /�?I'J.�rzsC/J. X"s <br /> _.7'�%'-�'fi'' /;./�.L'%lt��.�'L-�(.1_.' s-'!-.f��J'�/`c;{' /1/C',�"i't/c:�'�;j fl.J4!✓..J'7"4:1:�)i. 1'�.+a/�%'.�'.cC' O/',/L/,�i1-�4" �r.'i;✓'.,.r-=,F-vi./�+= <br /> ,7�L;�S - <br /> y�'�1-.,��� <br /> a <br /> The undersigned hereby applies for permission to .excavate, construct and/or <br /> otherwiseencroachon County Highway Right-of-Way on the South - side of <br /> East 11th Street and Lovely Road approximately 10,700 feet/mile feet <br /> of 18 inch water main by performing the <br /> following work (description of work) : <br /> Installation of an 18-inch water main by oven-cut construction mcludin all water fittin s, valves. <br /> corrosion control system and connection to the existing City water infrastructure Work includes traffic <br /> control site restoration subgrade and pavement restoration and trench shoring <br /> Work will commence on or about Septem er 18, 20 77 for approximately <br /> 180 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 a <br /> / <br /> Signature of Applicant - Title —'Date <br /> KUTSR.PS\FRRS®L (6/00) - <br /> n4,7,,nn_nA_n2 nn; <br />