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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date July 10, 2008 OFFICE USE ONLY <br /> To: San Joaquin County JOB# j/�Jr�.}�!' REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE tr• 15'•Q8 <br /> Lodi Building Association VALID 10-_ p$ TO dl•JS•o$ DRIVEWAYS: <br /> (Applicant Name) STREET �- <br /> AREA jj9G QUAD A/,& <br /> P.O. Box 1505 TYPE 7X6&W— iAL4 <br /> (Mailing Address) FORMS -3s ww, ,e Lq <br /> NOTES <br /> Woodbridge, CA 95258 ti l y <br /> (City,State,Zip Code) <br /> 209-481-7587 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) - <br /> i <br /> See attached plans. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of Oranize Street approximately feet/mile North <br /> of Mokelumne Street Woodbridge by performing the following work(description of work): <br /> Installation of an 8" waterline from Mokelumne Street to the North end of <br /> Orange Street. <br /> Work will commence on or about August 18, 2008 for approximately 10 days. <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 the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signature of Applicant-Title Date <br /> E PUB-SVWNIMASTER.PSIENCROACHMENT PERMIT APPLICATION DOC (01108) <br />