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PS• i C!C?t�S� <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 4/29/2010 OFFICE USE <br /> To: San Joaquin County JOB# 1405- REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE l 7of <br /> Turner Construction Company VALID f p DRIVEWAYS: <br /> (Applicant Name) STREET :AREA 2nclt? V QUAD 5 <br /> 1211 H Street TYPE <br /> (Mailing Address) FORMS FORMS <br /> Sacramento, CA 95814NOTES -------- - __—_ <br /> (City, State, Zip Code) -- -- <br /> 916-444-4421 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Plan attached. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highwa�Right-of-Way on <br /> the South side of Farm Street/E Miner Ave <br /> approximately 100 fee mile East <br /> of N Oro Ave . <br /> , by performing the following work(description of work) <br /> _Closing both streets, removing asphalt/base rock, installing underground <br /> utilities L--- <br /> rocking_and repaving both roads . Once work is com lete streets <br /> �— <br /> Work will commence on or about_ 2 8 May 2 010 for approximately 60 <br /> 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 /> I <br /> a <br /> ate _ <br /> g PP�' w <br /> Si nature of Applicant Title Qate <br /> E IP(163VVKWA 1TE RP:i CN FJF[;NM=f U.?dPP'. ',ration X01,)8) <br />