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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 8/08/2012 <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB REF# <br /> Department of Public Works APN CR# <br /> CVIN, LLC EXP. DATE 3 i3 <br /> VALID 6, TO 3 DRIVEWAYS: <br /> (Applicant Name) STREET <br /> ,D. <br /> 855 M St. Ste. 1120 AREA / QUAD <br /> TYPE <br /> (Mailing Address) FORMS <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 er fission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the�zrrN side of y A, <br /> � r� <br /> /rU�� �TJ�'�� - <br /> , by performing the following work(description of work): <br /> McHenry Ave and E River Rd and a portion of the Mchenry bridge within San Joaquin County-See plans for details. <br /> Work will commence on or about for approximately 60 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 /> g/S /1;7 <br /> Signature of Applicant-Title Date <br /> E]PUB-SV.WKIMASTER.PSIENCROACHMENr PERMIT APPLICATION.DOC (01108) <br />