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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date February 18, 2020 <br />To: San Joaquin County <br />Department of Public Works <br />Joe <br />(Applicant Name) <br />PO Box 2180 <br />(Mailing Address) <br />Lodi, CA 95241-2180 <br />(City, State, Zip Code) <br />209-334-6613 <br />(Area Code - Telephone Number) <br />jmurphy@dillonandmurphy.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />See attached <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR# <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE " <br />FORMS <br />NOTES <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the North side of Mariposa Road approximately 1,263 feet/arpjle South East <br />of E. Munford Avenue , by performing the following work (description of work): <br />The Drolect is Dr000sina to build a bridge to provide access from the Droiect site 4315 Mariposa Road to a county road. The work <br />on the county road will include footina for the bridge. Davina approach at the county road and striping. A copy of the plan set showing <br />Work will commence on or after March 1, 2020 for approximately 30 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 <br />r�owa n n:saxcxoncxnexrpEnurtpvwicpnoxew(anroe( <br />2- to- -zv <br />Date <br />