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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2-19-22 <br />To: San Joaquin County <br />Department of Public Works <br />Arnaudo Bros., Inc <br />(Applicant Name) <br />16505 S. Tracy Blvd. <br />(Mailing Address) <br />Tracy, CA 95304 <br />(City, State, Zip Code) <br />III :R1011M18I-1 <br />(Area Code - Telephone Number) <br />garreft@arnaudoinc.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) See Attached. <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 />3/30/2022 TO 5/1/2022 DRIVEWAYS: <br />Finck Rd. <br />Tracy QUAD SW <br />Bore <br />Ssfwvv <br />Special Conditions <br />******Permit is for a private pipeline under Finck Road.******* <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 Finck Rd approximately 1300' feet/mile west <br />of Tracy Blvd. , by performing the following work (description of work): <br />Bore 12" HDPE irriaation line under Fink Rd <br />Work will commence on or after March 1, 2022 for approximately 1 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 />�� it � � • • <br />Signature of Applicant - Title <br />V]FORN6&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />2-19-22 <br />Date <br />