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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date _gpr,1 10, 2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB ���� REF t <br /> Department of Public Works APN CR r _ <br /> Senior Awareness Day 2015 EXP.DATE <br /> San Joaquin County-Human Services Agency VALID p1/I TO t' DRIVEWAYS: <br /> Elise Vigil (Applicant Name) STREET <br /> AREA i.-=>- QUAD <br /> PO Box 201056 TYPE '' rfPD, tl �' ► /Ua lfi91t <br /> (Mailing Address) FORMS _ <br /> NOTES <br /> Stockton, CA 95201 <br /> (City,State,Zip Code) <br /> 209--468-1561 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) — <br /> See attached <br /> i <br /> I <br /> The undersigned hereby applies for permission to excavate,construct andbor otherwise encroach on County Highway Right-of-Way on <br /> the West side ofrMire GrQve Rd approximately 20 feet _ feet/mile 1 mile <br /> of _,by performing the following work(description of work),. <br /> we have a one dad evt Un Thursday, May?R, 2015 from 8 am to 1pm._. We asking <br /> for permission to park on the west side of Micke Grove Rd. along the park. The parking <br /> would begin south of the main entrance and end, just north of the most south entrance. <br /> _Parking would be limited to Vendors and st-a only, This limits the time that P_arkc ng <br /> will take from 6-8: 15 am and..from 12:30-1:30 pm. We will have STARS assistance-_during time. <br /> Work will commence on or about 6:00 am nn 512812015 for approximately.-__.. L days. <br /> I,the undersigned,certify that 1 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 San Joaquin County and subject to inspection and approval. <br /> Signatur of plic nt-Title 1 Date <br /> a <br />