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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 5/13/16 <br />To:San Joaquin County <br />Department of Public Works <br />Emre Ortakci (Parikh Consultants,Inc) <br />(Applicant Name) <br />2360 Qume Drive,Suite A <br />(Mailing Address).San Jose,California 95131 <br />(City,State,Zip Code) <br />(40B)452-9000 <br />(Area Code.Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />See the proposed boring location plan <br />OFFICE USE ONI.Y <br />JOB#-JI UOO)'REF# <br />:::""~~-16'"DRIVEWAYS:•~~~I~ET•~&t5f.mV~~/&IG •AREA?t:,,~Q AD 5£= <br />TYPE ~~• <br />FORMSj~R.'?9 <br />NOTES <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 McKinley Avenue approximately feetlmile _ <br />of ,by performing the following work (description of work): <br />A getaile~des riptioe 0'1"'9 F1ldRAea lielEi ':6,1<is aHacl,cet.'>X g 77 Bore -fQ r moa,-Ia clog 14«Ii <br />Work will commence on or about _6_/_7/_1_6 for approximately 5 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 />&Jv~Pr~3«~ <br />Signature of Applicant -Title <br />S//J/H <br />Date