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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To: San Joaquin County <br />JOB #REF # <br />Department of Public Works APN CR # <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />(Applicant Name)STREET * <br />AREA QUAD * <br />TYPE * <br />(Mailing Address)FORMS <br />NOTES <br />(City, State, Zip Code) <br />(Area Code - Telephone Number) <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on &ounty Kighway ULght-of-Zay on <br />the ______________ side of ___________________________________ approximately ____________ feet/mile _________ <br />of _______________________________________, ____________________, by performing the following work (description of work): <br />Work will commence on or after _____________________________________ 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 DateSignature of Applicant -Title <br />3/22/22 <br />RoadSafe Traffic Systems <br />PO Box 1270 <br />Verdi,NV 89439 <br />(775) 622-2950 <br />bstahl@roadsafetraffic.com <br />Please see attached TCP's for 3 locations flagging operations only. <br />EB/WB Roth Rd., Ash St., French Camp Rd.25 <br />the railroad tracks Near Harlan Rd. <br />Union Pacific Railroad intends to resurface their trains tracks near these locations requiring flagging operations only with advance warning signage only in the County Right of Way <br />4/15/22 8-12 days <br />3/22/22