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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date May 2, 20114 OFFICE USE ONLY <br /> To: San Joaquin County JOB# loam REF# <br /> Department of Public Works APN CR# <br /> Mark & Kandee Aiton EXP.DATE ►Z 14 _ <br /> On Your Mark' Events VALID rs (4 TO 7 12, 14 DRIVEWAYS: <br /> (Applicant Name) STREET aon6op�,E&D, 14&--Ack 99- ' <br /> AREA toot QUAD "IJ <br /> PO Box 1 1 9 9 TYPE --i-A-44P 4AD eZD5a46, -fMifiG eatV gi-2VI665 <br /> (Mailing Address) FORMS / <br /> NOTES <br /> Arnold, CA 9;5223 <br /> (City,State,Zip Code) E dA1 7 /4 0 <br /> 209-795-78321 D: o Al. aE <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) t/E 365S',�' ,f?_/A/* <br /> See attached Letter of Intent and Map - Start date, July 12, 2014 <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 feef/mile <br /> of by performing the following work(description of work): <br /> Sea attached <br /> Work will commence on or about 7/12/14 for approximately 1 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 de ribed above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> (1 1) 1 May 2, 2014 <br /> L, 7 1Signature of Applica -Title Date <br />