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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date May 17, 2012 OFFICE USE ONLY <br /> To: San Joaquin County JOB# __//0005_ REF <br /> Department of Public Works APN CR# <br /> EXP.DATE !T — <br /> Senior Awareness Dav—SJC—HSA—AnnetteDePauliVALID S 3t rz T6 DRIVEWAYS: <br /> (Applicant Name) STREET MtcicE oJF Rid, <br /> AREA pl> QUAD . /f� <br /> PO BOX 201056 TYPE _rcmp• ruv pAew A411W)9tic� <br /> (Mailing Address) FORMS " <br /> NOTES <br /> Stockton, CA 95201 <br /> (City,State,Zip Code) <br /> __(209) 468-1374 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Sze Attached <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the west sideof Micke Grove RD approximately 20 feet feet/mileapprox. lmile <br /> of I ,by performing the following work(description of work): <br /> We have a one day event on May 31 2012 from 8AM-1PIN1 We are asking for permission to <br /> park on the west side most south entrance Parking will be limited to vendors and staff <br /> only. This limits the time that parking will take place from 6AM--8: 15AM & 12:30PM-1.30PM. <br /> We will have STARS assistance during this time and staff with radios and safp8v ge_ ar to <br /> monitor traffic to ensure the safety of the cars parking and unyarkin <br /> Work will commence on or about—...5./31/12 for approximately t (one) 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 /> Signature of Applicant•Title Date <br /> Annette DePauli, Adult Services Division Chief <br /> t'.+t:vSV WY',M VS RP8'FNCi1_arahretJT F�au.I aPa11_FT'JN Com.r);7F <br /> l <br />