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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date j1, � �" < ' OFFICE USE ONLY <br /> To: San Joaquin County JOB# 11.0005- REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE t t 20 O <br /> {{ ,. # TRt `r VALID `p t� TO i to 2 o t o DRIVEWAYS: <br /> (Applicant Name) STREET tt�cxfl <br /> AREAQUAD <br /> C ' �►aru �A)a-pec S a ►oas <br /> TYPE ,. <br /> (Mailing Address) FORMS <br /> NOTES <br /> (City, State, Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Sundance Running Club of Stockton wishes to sponsor and hold the CALIFORNIA-10 road 10 mile and <br /> I OK running races on Sunday, 10 January 2010.The starting time is 9:00 AM and a duration of three(3) hours <br /> expected.The proposed race courses would begin and end on the grounds of San Joaquin General Hospital and <br /> utilize sections of Manthey, Mathews and Howard Roads. The basic course layout is shown on the attached <br /> diagram and will require limiting cross traffic on Manthey,Mathews and Howard Roads while racers are present. <br /> the two(2)water stations will be set up along the roadside on Howard Road at the 3 and 5 mile points of the race. <br /> 'The Sundance Running Club can provide necessary signage to be placed at designated intersections indicating <br /> that a road race is in progress. <br /> All proceeds from the event(after expenses)will be donated to Team Fox for Parkinson's Research. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of approximately feet/mile <br /> of by performing the following work(description of work): <br /> Work will commence on or about for approximately 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 /> Signature of Applicant-Title-/ Date <br /> EIPUBSVWKIMA.STERPSIENCROACHMENT PERMITAPPLICAI.ION.DOG ;OV08) <br />