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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date o8/o9/22 <br />To: San Joaquin County <br />Department of Public Works <br />Q&N Construction <br />(Applicant Name) <br />891 N, Broadway Ave <br />(Mailing Address) <br />Stockton, CA 95205 <br />(City, State, Zip Code) <br />(209)956.6000 <br />(Area Code - Telephone Number) <br />pgoesQg and nconstructio n.com <br />(Email Address) <br />Sketch (Detailed plans may be s <br />SEE ATTACHED PLANS <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREETyrv�an <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />110005 REF# <br />CR # <br />TO DRIVEWAYS: <br />Ave " <br />8tockton QUAD NIS <br />Tench, Temp Road Closure <br />rench Cut Policy <br />Special Conditions <br />*****Myran Ave. Closed on 10/11/2022 to <br />10/13/2022 from 7:30 AM to 4:00 PM <br />opened <br />to thru traffic during non-workin hour ***** <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 Myran Avenue approximately 150 QfeeV0Mile south <br />of Florida Avenue Stockton by performing the following work (description of work): <br />Work will commence on or after 10/10/2022 i for approximately I I 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 />`�6 res"-"u <br />ign tureofApplicant-Title <br />9-11"a <br />Date <br />