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hoc / <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 7/9/2014 OFFICE USE ONLY <br /> To: San Joaquin County JOB# j �)()S REF# <br /> Department of Public Works APN CR# <br /> Steven Hui EXP.DATE <br /> VALID y TO ( -/ - DRIVEWAYS: <br /> (Applicant Name) STREET E flAd kJ <br /> AREA C5 Ca If-)h QUAD S — <br /> 8 River Park PI, E.3 TYPE <br /> (Mailing Address) FORMS 55 W 2 <br /> Fresno, CA 93720 NOTES <br /> (City,State,Zip Code) <br /> 925-927-0990 <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 Escalon Bellota Rd approximately 487 feeVffl4e North <br /> of Escalon Bellota Rd and Dove Rd intersection Escalon, CA by performing the following work(description of work): <br /> Replace Deteriorated Pole <br /> PM 31079522, Not: 107997951, Location 1 <br /> Work will commence on or about a 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 /> 7/9/2014 <br /> Signature of Applicant-Title Date <br /> MICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATIONAOC (09113) <br />