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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date i VS� ) OFFICE USE ONLY <br /> To: San Joaquin County JOB# ? �� REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Esteban Ruiz �(� 1 VALID TO 1-1 - IS DRIVEWAYS: <br /> (Applicant Name) STREET arD`7(, ; <br /> AREA QUAD } <br /> TYPE <br /> (Mailing Address) FORMSyj <br /> NOTES <br /> : GSL i C� �agv� <br /> (City,State,Zip Code) <br /> (925)327-0990 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the west side of Murphy Rd approximately 580' feet/mile south <br /> of CA-120 Ripon,CA by performing the following work(description of work): <br /> Replace deteriorated pole <br /> PM 31119014 <br /> Notif: 109590367 <br /> Work will commence on or about CJ I I-il for approximately days. <br /> I,the undersigned,certify that I am the owner of the respective properfy,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 /> Signature of Applican a Date <br /> M\CENTRALSERVICES':CLERICALNPUD-SV.WNW.ASTER.nftICROACHMENTPER!dRAPPLICATION.DOC(nq <br />