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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 10/2/15 OFFICE USE ONLY <br /> To: San Joaquin County JOB# j t off,(-! REF# <br /> Department of Public Works APN CR# <br /> Drew Boriolo EXP. DATE 1 J-(- l S <br /> Teichert Construction VALID M-9'-IJ TO <br /> DRIVEWAYS: <br /> (Applicant Name) STREET 7"racv B V,40rd R4—f*C" (&V� F <br /> 265 Val Dervin Parkway AREA QUAD 1 51,/ <br /> TYPE <br /> (Mailing Address) FORMS f� <br /> Stockton CA 95201 NOTES <br /> (City, State,Zip Code) <br /> (209) 598-5589 <br /> (Area Code-Telephone Number) <br /> d b ve la to t 0;1A <br /> Sketch (Detailed plans may be submitted) <br /> Please see attached plan and schedule <br /> The undersigned hereby applies for perpiss%ty excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of ee an approximately feet/mile <br /> of I , by performing the following work(description of work): <br /> See plan, need to set signage for and run detour on Tracy Blvd <br /> Howard Rd, Stark Rd and Maybeck RD <br /> Work will commence on or about 10/16/15 for approximately 3 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✓0 tic, YYicw.ct1c�1/ 10/2/15 <br /> '19,gna re of pplicant-Title Date <br /> E:1PUB-SV.VJKIMASTER.PSIENCROACHMENTPERMITAPPLICATION.D00 (01/08) <br />