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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 11/16/11 <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# '7.5c�6f'f� REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE A. /i <br /> CVIN, LLC A <br /> VALID Z/�$ i T / DRIVEWAYS: <br /> (Applicant Name) STREET <br /> 855 M St. Ste. 1120 AREAS i QUAD <br /> TYPE �_T les <br /> (Mailing Address) FORMS ,s <br /> /�t/�U .F-•�1 <br /> Fresno, CA 93721 NOTES <br /> (City,State,Zip Code) <br /> 559-442-6010 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See attached plans <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 <br /> of approximately feeUmile <br /> by performing the following work(description of work): <br /> McHenry Ave,French Camp Rd.,S.Austin Rd.,Arch Rd.,Pock Ln.,Carpenter Rd.,E.Mariposa Rd.E.Charter Way-See plans for details,various streets in County right of way <br /> Work will commence on or about 1/3/2012 for approximately 30 <br /> days. <br /> 1,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 /> o— <br /> ` +tl�bl2d� <br /> ignature o nt-Title Date <br /> E1PU&SV. STE.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />