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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date May 20 ,2014 <br /> OFFICE USE ONLY <br /> To San Joaquin County JOB# REF# <br /> Department of Public Works APN CRN <br /> EXP. DATE Z9 !� i <br /> Senior Awareness Day 2014 VALID S 2 14 TQ SiqP DRIVEWAYS <br /> San Joaquin County- Human Services Agency <br /> Annette DePauli STREET 6 99E fi <br /> AREA G4D/ QUAD N <br /> (Applicant Name) TYPE 1JMfV- fARy "*NO PA.eku►/6''GJ4)Wje — <br /> P.O,. Sox 201056 FORMS <br /> ( Mailing Address) NOTES <br /> Stockton, CA 95201 <br /> (City, State. Zip Code) <br /> 209-468-1374 — -- -a- <br /> {Area code-Telephone Number) <br /> Sketch (Detailed plans my be submitted) <br /> See attached <br /> i <br /> I <br /> The Lndersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right- <br /> of-Way on the West side of Micke Grove Rd_approximately_20 feet feet/mile_apprx. 1 <br /> mile <br /> of by performing the following work(description of work) <br /> We have a one day event on May 30 2013 from 8 am to 1 pm We are asking for permission to park on the west side <br /> of Micke Grove RD in along the Park. The parking would begin south of the main entrance and end just north of the <br /> most south entrance. Parking will be limited to Vendors and staff only This limits the time that parking will take be in <br /> actio-, from 6:00-8:15 am and from 12:30-1:30 pm We will have STARS assistance during this time and staff with radios <br /> and safety gear to moritor traffic to ensure the safety of the cars parking and <br /> unpa kk --- <br /> Work will commence on or about_6:00 am on 5129/14_for approximately_1 _day <br /> 1, the undersigned, certify that I am the owner of the respective property, or am qualified to represent the owner and <br /> agree to do the work described above in accordance with the rules and regulations of San Joaquin County and subject <br /> to inspection and aIppr2al. <br /> Signature of Applicant-Title Date <br /> ..n VASTEP P'ZNC:BQ=.'Hb!-'a PER f.' gF:PJCAI'.QPf OO[ <br />