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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �cL y i �� <br /> —� I OFFICE USE ONLY <br /> To: San Joaquin County rAP <br /> # <br /> Department of Public Works � ' � REF# <br /> CR# <br /> Mozingo Construction, Inc . EXP.DATE <br /> VALID < TO T—. <br /> (Applicant Name) STREET — __ DRIVEWAYS: <br /> SG,4Gta�tr-lit �n <br /> 751 Wakefield Court AREA UAD <br /> (Mailing Address) FORMS <br /> Oakdale, CA 95361 NOTES <br /> (City,State,Zip Code) <br /> 209/848-0160 (Nicole Davis) <br /> (Area Code-Telephone Number) <br /> FSketch,D—etailel plans may be submitted) <br /> ttached plan sheets C-01, C-02, and C-03 by Nolte Associates . <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 Escalon-Bel Road y <br /> of approximately 900 feet/r5 _ <br /> __Installation of potable waterlines in Farurierfo <br /> n f n tfollowing <br /> and <br /> and con,9tr2icted <br /> Work will commence on or about_ FA_ hr„�ry�� <br /> 0� � for approximately 3 0 <br /> I, the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner days. <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval, <br /> and agree to do the <br /> t� ,3 r ��' �j CClY�LQF JI • <br /> Signature of Applicant Title ' f <br /> Date <br /> EIPU&;,V WKIMASlER.PSkENCROAGRMENl PERMIT APpLIChT10NDG-- (07/08) <br />