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APPLICATION run ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 410501020 <br />To: San Joaquin County <br />1 11 Department of Public Works <br />�io�z IRP=P �r � MFCS . Tie., <br />(Applicant Name) <br />moo. aox 161 <br />(Mailing Address) <br />i OBJ Ca- 95234 <br />(City, State, Zip Code) <br />(Area Code - Telephone Number) <br />r b ux' % 6 I» I . <br />ail Address) nom{ <br />Iketch (Detailed plans may be submitted) <br />�pp1�Ga�Vit }o+ <br />p3Y ��Z�t t-awt 0VJVIoiMk2{ <br />a) .- p�vlpl4 jl Ai3 0V1 tOPOM 514t4e aF M(�Dnna.lol <br />«lmv�d Yew <br />pN� M 90✓1ttr1?,v1te. I-600 <br />ntt�) is <br />_ Pv,vlola s e ►vp e rer"VOA of I rP\4FFIL "Jn+vo l o a.J1k�Cc, dLt-" Vy rlAv1 <br />z)_ peporr �rcvlwav� a��ie1- 1v1cNIiANm (/� K Yip rs. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County High <br />Ight-of•Way on <br />the � oTV1 side cf M (.V'JO Vln,l� I�,lelVicl Rrund approximately fee Ile vJ.F.St <br />of b 1011 by1 Homo! by performing the following work escdpdon of work): <br />Work will commence on ar after. ur�l�, r�o7,o for approximately tis 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 />Signa eyr o optica ft to <br />rroaw&rrurunscxca %orraurt wur xazpean <br />OFFICE USE ONLY <br />JOB# <br />110005 REF# <br />APN <br />CR # <br />EXP. DATE <br />5/21/2020 <br />VALID <br />5/13/2020 TO 5/21/2020 DRIVEWAYS: <br />STREET <br />McDonald Island Rd <br />AREA <br />Delta QUAD SW <br />TYPE <br />Trench, Traffic Control Devices ' <br />FORMS <br />SSANVV R-29 <br />NOTES <br />SJC Road Maintenance to Install/MaintainlRemove <br />Traffic Control Devices and Re ave McDonald <br />Island <br />Rd. After Installation of <br />New Pipes. <br />Iketch (Detailed plans may be submitted) <br />�pp1�Ga�Vit }o+ <br />p3Y ��Z�t t-awt 0VJVIoiMk2{ <br />a) .- p�vlpl4 jl Ai3 0V1 tOPOM 514t4e aF M(�Dnna.lol <br />«lmv�d Yew <br />pN� M 90✓1ttr1?,v1te. I-600 <br />ntt�) is <br />_ Pv,vlola s e ►vp e rer"VOA of I rP\4FFIL "Jn+vo l o a.J1k�Cc, dLt-" Vy rlAv1 <br />z)_ peporr �rcvlwav� a��ie1- 1v1cNIiANm (/� K Yip rs. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County High <br />Ight-of•Way on <br />the � oTV1 side cf M (.V'JO Vln,l� I�,lelVicl Rrund approximately fee Ile vJ.F.St <br />of b 1011 by1 Homo! by performing the following work escdpdon of work): <br />Work will commence on ar after. ur�l�, r�o7,o for approximately tis 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 />Signa eyr o optica ft to <br />rroaw&rrurunscxca %orraurt wur xazpean <br />