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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT:' <br /> Date 2-29-08 OFFICE USE ONLY <br /> To: San Joaquin County JOB # ��� � REF # <br /> Department of Public Works APN CR # — <br /> EXP. DATE <br /> David Castro VALID. TO DRIVEWAYS: <br /> (Applicant Name) STREET �'s12 l� DC' <br /> 4622 Glass Court, Suite A AREA ` (Itfd & UAD Pl <br /> TYPE `-5 <br /> (Mailing Address) FORMS <br /> Modesto, CA 95354 NOTE <br /> (City, State, Zip Code) <br /> 209-522-6273 <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 <br /> otherwise- encroach on County.. Highway Right-of-Way-on the See attached. side.of <br /> approximately feet/mile <br /> ofr , by "per€orming the <br /> following work (description of work) : Geotechnical soil borings in unipaved <br /> shoulder areas <br /> Work will commence on or about March 12th for approximately <br /> 5 days. <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent i;he owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval, <br /> /izJ/E2T 2-29-08 <br /> Sign re of icant Title Date <br /> FUSIRR.PS\FBBSC'BDU (6/00) <br /> I <br />