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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 7/10/2014 OFFICE USE ONLY <br /> To: San Joaquin County JOB# a,<>052 REF# <br /> Department of Public Works APN CR# <br /> Steven Hui EXP.DATE 5 <br /> VALID TO -(5 DRIVEWAYS: <br /> (Applicant Name) STREET 6L-dao 19'd l6lr <br /> AREA J Sc -70 QUAD <br /> 8 River Park PI, E.3 TYPE <br /> (Mailing Address) FORMS 55 1/ /e Z cf <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. East side of Escalon Bellota Rd approximately 237 feeyfff & North <br /> of Escalon Bellota Rd&Magnolia Rd intersection Escalon, CA by performing the following work(description of work): <br /> Replace Deteriorated Pole <br /> PM 31079522, Not: 107997955, Location 5 <br /> Work will commence on or about 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 /> 4& <br /> �' 7/10/2014 <br /> Signature of Applicant-Title Date <br /> M:ICENTPALSEP.VICESICLEP.ICALIPUB-SVIWWASTER PSIEIICROACHIAEIIT PERMITAPPLIC.ATION.DOC (09/13) <br />