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PLEASE PRINT: APPLICATION FOR ENCROACHMENT PERMIT <br /> Date <br /> 5!i <br /> Tc: San Joaquin County OFFICE USE ONLY <br /> Department of Public Works JOB# �f- �a�� REF# <br /> APN --__ <br /> EXP. DATE <br /> AnAnnette27 <br /> e DePauii ! VALID �—~ <br /> (Applicant Name) ° � TO 3`,�j ___ <br /> STREET ,,C� p DRIVEWAYS <br /> P.O. BOX 201056 AREA — '4 <br /> (Mailing AddreQUAD <br /> ss) TYPE °��jv�� * _ <br /> FORMS .. <br /> Stockton CA 0520� ----_ <br /> (City, State,Zip Code} NOTES <br /> '209 468-1374 — — — <br /> (Area code—Telephone Number) <br /> Sketch (Detailed plans my be submitted) <br /> See Attached <br /> i <br /> The undersigned hereby applies for permissio <br /> Of-Way on the n to excavate; construct and/or otherwise encroach on County Highway Right- <br /> west side of Micke Grove Rd. <br /> __approximately 1.000 <br /> Of the shoulder y_ feet/mile <br /> Tem oraril waive the current"no arkin by <br /> on the west shoulder of Mic <br /> ark ke <br /> er endicular to the outer boundar fence of Micke Grove Park <br /> performing the following work (description of work): <br /> would be arked b 8:00 amthe 1.Vark. Cars arked in the area would bead ellow cars to <br /> ndors who <br /> Traffic monitoringwith 3 fla ers(would be se t at each end. <br /> end of the event and would not be movin Burin that time. <br /> Work will commence on or about 7:00 am to 2:00 m Ma 27 2010 fora approximately <br /> i, the undersigned, certify pp mately 7 hs of 1 day <br /> 9 ertif that I am the owner of the respective Property, or am days. <br /> agree to do the work described above in accordance with the rules and regulations of San <br /> to inspection and a qualified to represent the owner and <br /> approval, <br /> Joaquin County and subject <br /> Signature of Applicant—Title <br /> E.PUS-SV.`WMASi<R PS',E'jCROACWENT PERM7 APP_;CA'IO:V.DG,� Date <br /> �"03 <br />