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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/10/2020 <br />To: San Joaquin County <br />Department of Public Works <br />Mozingo Construction Inc. <br />(Aicant <br />pplName) <br />751 Wakefield Court <br />(Mailing Address) <br />Oakdale, CA 95361 <br />(city, State, Zip Code) <br />209-848-0160 <br />(Area Code -Telephone Number) <br />kaltamirano@mozingoconstruction.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />Please see attached. <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />/?100057 REF # <br />CR # <br />3 S ?o <br />_ "� I, �� TO 31 S �2 o DRIVEWAYS: <br />01(44 1�9 <br />�FR�A CLI QUAD �tn� <br />`o r p , <.)A CL05LA <br />� '0 3& <br />�c t- eJ �r�daA3S 'p <br />I� �D»1 SOS"iEhi I�At7 (l�+Ld. � G(.o5�� MAi2.CN 7� 2dLo Feotit Co:00 Ai12 <br />�a To I1 tggCH S , ?tea 2cs TO G; 00 PM 6 2 - tw e6d5u►ee j <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right -of -Way on <br />the North &South side of Von Sosten Rd. approximately 50o feet feetlmile west <br />of Byron Rd. by performing the following work (description of work); <br />to install culvert crossing.P��,-}rewr.d,; <br />Work will commence on or after <br />3 <br />for approximately <br />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 tlo 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 />TEh1PLATE5IENCROACHh1ENT PERMIT APPIICATICN.doc �081a8) <br />Date <br />