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PLEASE PRINT: <br />Daffi 11/19/15 <br />j'-.•..•I,".~,j.L <br />SAr1 jU)~Jlil!\C.O:,:hTVAPPLICATIONFORENCROACHMENTPERMIT2a'1~DEC -1 1\1111;5 [J <br />iJEPi.01 i'U8L1C WORKS <br />OFFICE USE ONLY <br />To:San Joaquin County <br />Department of Public Works <br />Zabih Zaca <br />(Applicant Name) <br />325 Civic Center Plaza <br />(Mailing Address) <br />Tracy,Ca 95376 <br />(City,State,Zip Code) <br />209-831-6452 <br />(Area Code -Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />Detailed Plans Submitted <br />J08#IIO(}0'>REF# <br />APN CR# <br />EXP,DATE ,'3-/£-L6 <br />VALID (--j~/G TOB5-/b DRIVEWAYS: <br />STREET Wei/'So1/1 ~~• <br />AREA =Wac )/QUAD S W : <br />TYPE £imhlYlCj 8eQ(cm 0/1 C£)""Ie <br />FORMS $";'ItV),i./. <br />NOTES <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way ontheeast&west side of Patterson Pass Road &Mtn House Pkwy.approximately 500 feet/mile NB&SB approache <br />of 1-580 EB &[.580 WB Ramp intersections ,respectively ,by performing the following work (description of work): <br />Install solar-powered flashing beacon and use oftraffic control signs and devices during construction of signals an( <br />intersection improvements <br />Work will commence on or about January 15,2 °16 for approximately 5_0 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 ruies and reguiations of San Joaquin County and subject to inspection and apptovaL::;;:~;{2;J--:::::-l:'L""'"01,1,.1 t::i'9111"~1J 1/2.t,-II S- <br />Signature of Applicant -Title Date