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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date January 7,2009OFFICE USE ONLY <br /> To, San Joaquin County JOB PWP1 10005 REF# <br /> JO <br /> Department of Public Works . JOB CR <br /> EXP.DATE July 5,2009 <br /> Morada Produce Co., Lp VALID 1/07/09 TO 715/09 DRIVEWAYS: <br /> (Applicant Name) STREET Jack Tone Road <br /> AREA Linden Quad NE <br /> P.O.Box 659 TYPE Road Improvements <br /> (Mailing Address) FORMS SSNVW,R-29 <br /> NOTES <br /> Linden,CA 95236 ------ <br /> (City,State,Zip Code) <br /> (209)546-0426 <br /> (Area Code-Telephone Number) <br /> I, Sketch—(Detailed p-lans may-b e sub-mit—ted) <br /> JACK TONE ROAD I MPROVEMENTS- Part of PA-0700080(SA) <br /> The undersigned hereby applies for permission to excavate,construct andior otherwise encroach on County Highway Right-of-Way on <br /> the east —side of Jack Tone Road-----------.,-- approximately 1,500 ___feet north of <br /> o _ -Copperopolis Road <br /> by performing the following work(description of work): <br /> - -- ------- <br /> IMPROVEMENTS-widen ing, turn lanes, driveway approaches and striping,etc, <br /> Work will commence on or about _ ----1/07/09 for approximately 180 <br /> days. <br /> 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 /> y;FQkVS I'IRMI'API! A!lCh­I,Rft: <br />