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li5AvEP�, of <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date March 28,2011 <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# 11G�l�� REF# <br /> Department of Public Works APN C # <br /> _ /® <br /> Senior Awareness Day 2011 EXP. DATE V <br /> VALID TO S <br /> San Joaquin County- Human Services Agency DRIVEWAYS <br /> Annette DePauli STREET p. <br /> (Applicant Name) AREA X 4 D /1/GJ <br /> TYPE /lI0i�l✓� .G�/9f(,�LQ <br /> P.O,. Box 201056 FORMS <br /> ( Mailing Address) NOT <br /> Stockton, CA 95201 ,Aw -71" <br /> A.2 !9 ZD <br /> (City, State, Zip Code) <br /> 209-468-1374 <br /> (Area code—Telephone Number) <br /> Sketch (Detailed plans my be submitted) <br /> See attached <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right- <br /> of-Way on the West side of Micke Grove Rd_approximately_20 feet feet/mile_apprx. 1 <br /> mile <br /> of by performing the following work (description of work): <br /> _We have a one day event on May 26 2011 from 8 am to 1 pm. We are asking for permission to park on the west side <br /> of Micke Grove RD in along the Park. The parking would begin south of the main entrance and end just north of the <br /> most south entrance. Parking will be limited to Vendors and staff only. This limits the time that parking will take be in <br /> action from 6:00-8:15 am and from 12:30-1:30 pm. We will have STARS assistance during this time and staff with radios <br /> and safety gear to monitor traffic to ensure the safety of the cars parking and <br /> unparking. <br /> Work will commence on or about�5/26/11_for approximately_1 _day. <br /> I, the undersigned, certify that I am the owner of the respective property, or am qualified to represent the owner and <br /> agree to do the work described above in accordance with the rules and regulations of San Joaquin County and subject <br /> to inspection and app oval. <br /> r <br /> Y -77 j <br /> Signature of Applicant—Title Date <br /> E.1PUB-SV.WKWASTER.PS\ENCROACHMENT PERMIT APPLICATION.DOC <br /> (01/08) <br />