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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date May 13,2016 OFFICE USE ONLY <br />DRIVEWAYS: <br />A:'. <br />REF# <br />CR# <br />JOB#//OtlJ5 <br />APN <br />EXP,DATE <br />VALID '14> <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />San Joaquin County <br />Department of Public Works <br />Mark &Kandee Aiton <br />On Your Mark Events <br />(Applicant Name) <br />PO Box 1199 <br />(Mailing Address) <br />Arnold,CA 95223 <br />(City,State,Zip Code) <br />209-795-7832 <br />(Area Code.Telephone Number) <br />To: <br />Sketch (Detailed plans may be submitted) <br />See attached Letter of Intent and Course Map -Start day July 10, <br />2016 <br />The undersigned hereby appiies fll:J'ermis~on t'keXft'1¥ate,construct and/orotherwise encroach on County Highway Right-ai-WayanthesideofnnelCapproximatelyfeellmile_ <br />of ,by performing the following work (description of work): <br />lOQ""tt"CflQQ <br />SHE 365 Run from 6:00 am to 10:30 am <br />Work will commence on or about ,Ill]Y 10,201 6 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 des rtbed above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />\ <br />May 13.2016 <br />Date <br />E,IPUa..sV.WKW)'STER f'5\ENCROACllMENT PERMIT APPLICATION,O<X:(qI,(I8)