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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 04/01/2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB REF# <br /> Department of Public Works APN CR# <br /> RICHARD KNIGHT EXP.DATE <br /> VALID -ry s TO _q-'._15 DRIVEWAYS: <br /> (Applicant Name) STREET F' 0414rr R <br /> 8 River Park PI, E.3 AREA 441,411,19n -- QUAD &F� <br /> TYPE &V-o <br /> (Mailing Address) FORMS S S 14/4/ <br /> Fresno, CA 93720 NOTES <br /> (City,State,Zip Code) <br /> 925-242-0454 <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 NORTH side of E FUNCK RD <br /> of S WAVERLY RD approximately 420' feet/m4e. WEST <br /> FARMINGTON,CA _ by performing the following work(description of work): <br /> Replace Deteriorated Pole <br /> PM 31119161, Not: 109590422, Location 1 <br /> Work will commence on or about 07/10/2015 _for approximately one 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 accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> 04/01/2015 <br /> Signature of Applicant-Titf6 Date <br /> M10ENTRALSERVICESICLERICALIPUB-SV.INKIMASTER PSIENCROACHMENT PERMIT APPLICATION DOC (09113) <br />