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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date April 9, 2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# `j0 0 0-4!�, REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> ICity of L ado VALID ;S Il t TO /► tg DRIVEWAYS: <br /> (Applicant Name) STREET P- F-qA1ZLnD PD., <br /> AREA &Jccxsj&gt06&QUAD AJW <br /> P. 0 Box 30061221 IN Pine- St TYPE —1,C-PAR (ZoAb CL,-DSL;" a PXzK)P4 <br /> (Mailing Address FORMS �E�AtSa <br /> NOTES <br /> II ndL_Ca 95240 eflo Pia ti j n2 ,42 <br /> (City,State, Zip Code) <br /> 909---1�33-677 ct-bsuec p soa PIK -M <br /> (Area Code-Telephone Number) tc® <br /> Sketch (Detailedlans may be submitted <br /> SEE ATTACHED TRAFFI CONTROL PLAN. <br /> PLACEMENT OF TRAFFIC CONTROL AND SIGNAGE. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the N/A side of approximately feet/mile <br /> Of ,by performing the following work(description of work): <br /> Placement of"No Parking"signs (5/8, 9, 10, 11) on Lower Sacramento Rd from Mokelumne St south to City <br /> limits. Traffic control barricades and signage (5111)for the AMGEN Bicycle Race. see attached traffic <br /> centfel plan. <br /> Work will commence on or about for approximately 4 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 /> O <br /> wor escribAUed above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval, <br /> s - � <br /> N k�-- <br /> G— <br /> Srgnature of Applicant-Title Date <br /> rva WS&W*tAN$1ENTintb,tTP8 r 4CAT*"emro&41 <br />