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C 0�v:is U i i ���Y Y <br /> APPLICATION FOR ENCROACHMENT PERMIT 5 4A"IVN <br /> I AUG 24 M 4: 38 <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# -i „60-S-2-(g REF# <br /> Denartment of Public Works APN CR# <br /> PG&E EXP. DATE 2 ` _ <br /> VALID %0 - t$ 0 2 ! P�0 DRIVEWAYS: <br /> (Applicant Name) STREET tel.. y��l� RD. <br /> 850 STILLWATER RD. AREA =5eA1,e^1 QUAD <br /> TYPE �oLE �EPt-AGS n�tE�f. �” <br /> (Maiiinn Adrlraccl FORMS <br /> W SAC. CA 95605 NOTES <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> PM# 31139055 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the E. GAWNE RD.side of S. SECURITY WAY approximately 415 feet/mile FT <br /> of , by performing the following work(description of work): <br /> REP[ AGE l7 T RIORAT D POI F <br /> Work will commence on or about ' rl `(_ � 4V]�Qor approximately 1 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 /> TONY LIN -CONSUTLING FIELD ENGINEER II 7/15/2015 <br /> Signature of Applicant-Title Date <br /> IAiCENTRALSERMES,CLERICALTUB Sl,Yl'MFAASTER.PSIENCROACHMENTPERPA(TAPPLICATION.000 (05113) <br />