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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date November 16, 2019 <br />To: San Joaquin County <br />Department of Public Works <br />Lincoln Music Boosters <br />(Applicant Name) <br />PO Box 691044 <br />(Mailing Address) <br />Stockton, CA 95269 <br />(City, State, Zip Code) <br />(209)598-3243 <br />(Area Code - Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />See attached map <br />Xhl <br />g:3o 4W �rb 2:36 pr -t <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 feet/mile <br />of Lincoln, Leesburg, Ben Holt,Harr by performing the following work (description of work): <br />Band Review Parade <br />Work will commence on or about _November 16, 2019_ for approximately 1/2 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 i accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />atu of App icant - Title Date <br />E:NUS-SV.WKUMSTER.PSIENCROACHMEM PQiMiTAPPLICATI0N.000 (011 <br />0E) <br />OFFICE USE ONLY <br />JOB # <br />//pO REF # <br />APN <br />CR # <br />EXP, DATE <br />/ /0 19 <br />VALID <br />////&//g T6 &%/37 DRIVEWAYS: <br />STREET <br />AREA <br />WAI ,9, <br />5:721eA QUAD <br />TYPE <br />��KfP. XaAD <br />FORMS <br />NOTES <br />Xhl <br />g:3o 4W �rb 2:36 pr -t <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 feet/mile <br />of Lincoln, Leesburg, Ben Holt,Harr by performing the following work (description of work): <br />Band Review Parade <br />Work will commence on or about _November 16, 2019_ for approximately 1/2 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 i accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />atu of App icant - Title Date <br />E:NUS-SV.WKUMSTER.PSIENCROACHMEM PQiMiTAPPLICATI0N.000 (011 <br />0E) <br />