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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date January 31,2013 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 3 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Visionary Home Builders of California, Inc VALID /3 0 61-1!61-13 DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREAd�j� QUAD <br /> 315 N.San Joaquin St. TYPE �' C111141 <br /> (Mailing Address) FORMS 5 Lua) <br /> NOTES <br /> Stockon,Ca <br /> (City,State,Zip Code) <br /> 209-466-6811 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the south side of Mariposa approximately <br /> feettmile <br /> of ,by performing the following work(description of work): <br /> The work is on both sides of Frontage Road south of Mariposa Road.We are constructing a storm drain line from our project site to the <br /> Bieghle Drain and sewer lines to Loomis Road. <br /> Work will commence on or about March 2013 for approximately <br /> 60 days. <br /> I,the unde gne ,certify t I wner o e respective property,or am qualified to represent the owner and agree to do the <br /> work des 'bed a ove i co ance with a le and regulations of San Joaquin County and subject to inspection and approval. <br /> �3 <br /> ature o pplic - r e Date <br />