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( <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> 1/22/2014 <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# N0059 REF# <br /> Department of Public Works APN CR# <br /> PG&E EXP.DATE <br /> VALID 3/itl, t TO 11 1 DRIVEWAYS: <br /> (Applicant Name) STREET <br /> 4040 WEST LN AREA 'QUAD <br /> TYPE ;XXO-ALe:el G� <br /> (Mailing Address) FORMS , <br /> STOCKTON, CA 95204 nr��,(! MOTES <br /> �5 <br /> (City,State,Zip Code) P�Jr <br /> 209-942-1421 Z <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> SEE ATTACHED <br /> PM 31026585 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the SOUTH side of T ARCR Rn approximately 1`17.5 1 feet/mile EAST <br /> of CORRAL HOLLOW RD , TR Ary _, by performing the following work(description of work): <br /> TPF.NCTJ 441 TO TNSTALL NEW DEEP WET-I, ANCIDE <br /> 5114 <br /> Work will commence on or about for approximately !try 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 Sari Joaquin County and subject to inspection and approval. <br /> 1/22/2014 <br /> Signa a of Applicant-Title Date <br /> E:1PUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC(01108) <br />