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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date <br />To: San Joaquin County <br />Department of Public Works <br />Unden High School - Linden Unified School District <br />(Applicant Name) <br />18527 E. Front Street <br />(Mailing Address) <br />linden, CA 95236 <br />(City, State, Zip Code) <br />(209) 887.3073 <br />(Area Code • Telephone Number) <br />lacolombini@lindenusd.com <br />(Email Address) <br />may <br />See Attached. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the side of approximately Q feet/ Q mile <br />Work will commence on or after 9115/23 for approximately 1 days. <br />I, the undersigned, certify that I <br />work described above in <br />Signature of <br />of the respective property, or am qualified to represent the owner and agree to do the <br />rules and regulations of San Joaquin County and subject to inspection and approval. <br />G l -5 2� <br />D to <br />OFFICE USE ONLY <br />JOB # <br />110005 REF # <br />APN <br />CR # <br />EXP.DATE <br />VALID <br />TO 9/15/2023 DRIVEWAYS: <br />STREET <br />ro— <br />AREA <br />Linden QUAD <br />TYPEe—mp <br />Road Closure ' <br />FORMS <br />------ <br />NOTES <br />Special Conditions <br />In en Homecoming arae " <br />Friday, September 15, 2023 <br />1:30 PM to 3:00 PM <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the side of approximately Q feet/ Q mile <br />Work will commence on or after 9115/23 for approximately 1 days. <br />I, the undersigned, certify that I <br />work described above in <br />Signature of <br />of the respective property, or am qualified to represent the owner and agree to do the <br />rules and regulations of San Joaquin County and subject to inspection and approval. <br />G l -5 2� <br />D to <br />