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Rug- ZU• 2U14 1 : 11rn <br /> 1 I+v I !VL i <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 8/20/2014 <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# �/(,X-5- REF# <br /> Department of Pubic Works ApN <br /> CR# <br /> Linden High School E'•DATE. Q/ <br /> VALID / / T Q� DRIVEWAYS, <br /> {Applicant Name) STREET a <br /> 18527' E. Front St. AREA QUA <br /> (Mailing Address TYPE � � - <br /> � FORMS <br /> Linden, CA 95236 NOTES <br /> ------------ <br /> (city,State,Zip Cade) <br /> (209) 887-3073 <br /> i am <br /> (AAeR Code•Telephone Number) <br /> d - L4` USt) 887. 3 <br /> 7See <br /> ed plans may be submitted) <br /> attached map. <br /> The undersigned hereby applies for permission to excavate,conshuct and/or otherwise encroach on County Highway ftht-of-Way on <br /> the side of <br /> of approximppately feeUmile <br /> To close Front Street between DuncanbyRoadanh�foliowl work(desonptiono work): <br /> on September 19 2014 from 1 : 30 Sta. Highway 26 <br /> p.m. to 2:45 p.m. . <br /> Work will Commence on or about Se tember 1 9 2 01 4 for approximately one ( 1 ) <br /> 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 a000rdance with the tyles and regulations of San Joaquin County and subject to inspection and approval. <br /> � '�' 7 Linden High Scho'6ol Parade Committee <br /> Signature of scant-T141e 8/20/2014 <br /> Dat® <br /> +�+�wri+riaewoo� <br />