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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/7/22 <br />To: San Joaquin County <br />Department of Public Works <br />Haggerty Construction <br />(Applicant Name) <br />2474 Wigwam Drive <br />(Mailing Address) <br />Stockton CA 95205 <br />(City, State, Zip Code) <br />(209) 290-7190 <br />(Area Code - Telephone Number) <br />h.mendo a@haggertybuilds.com <br />(Email Address) <br />may <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />110005 REF # <br />CR # <br />04/20/2022 TO DRIVEWAYS: <br />Piccoli Rd. <br />Stockton QUAD NE <br />Frontage Improvements -Curb &Gutter <br />SSNW ,, R-1, R-6, R-7, R-13, R-18, R-29 <br />Special Conditions <br />*****Driveway Approaches are per the SJC Standard R-13 Owl.***** <br />Scope: <br />Frontage improvements to include curb and gutter, and concrete and asphalt paving work for new <br />driveway entrance along Piccolli Rd per Addendum plans by Michael Smith Engineering, Inc. <br />Includes saw cutting and patch back of trenches. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the West side of Piccolli Road, Stockton, CA approximately 32 feet feet/mile West <br />of Piccolli Road, Stockton, CA Piccolli Road, Stockton, CA , by performing the following work (description of work) <br />Stood <br />good <br />good <br />Imp—mont, to bond, oto dog q.,, no oondboodnd gggh,ft ­nq Rbb do, nowd,vo— ont—y, long oyboh Rd — oddond— logn, by %ch ddI Srl Endnddnnq In, I ndlfdd� gowy,ft- nd obtch obc, of flood, g <br />Fort <br />good <br />Work will commence on or after for approximately 15 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 />Dlglhlly sgned by to go mendura <br />Data 202203011320:10-00 00 3/7/22 <br />Signature of Applicant - Title <br />Date <br />