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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 04/14/2014 OFFICE USE ONLY <br /> hec�ev°G �i/i <br /> To: San Joaquin County JOB# `f 000 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE S/0 <br /> Linden-Peters Fire District VALID f TO p DRIVEWAYS: <br /> (Applicant Name) STREET Olkk4 RD- <br /> AREA /,,,,VZgA,) QUAD A1,,E <br /> 17725 E. Hwy 26 TYPE jjarsl-- PC A <br /> (Mailing Address) FORMS s <br /> NOTES <br /> Linden, CA 95236 <br /> (City,State,Zip Code) <br /> (209) 887-3710 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the N/S/E/W sideof Highway 26 approximately Duncan Rd. feedmile <br /> of by performing the following work(description of work): <br /> Collecting donations to benefit the Firefighters Burn Institute . <br /> Firefighters will be collecting donations from the shoulder of Hwy 26 and <br /> Duncan Rd a four way fio�) intersection. <br /> Work will commence on or about May 10th, 2014 for approximately one 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 accor e with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> 04/14/2014 <br /> -Signature of Applicant-tlDate <br /> 16 UB V.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />