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1I�,�'ZIZr <br />V r/rvv <br />APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Dale *7121 <br />% San Joaquin County <br />Department of Public Works <br />Zuckerman Herllaye, Inc <br />(ApplicardName) <br />PO Boz 481 <br />(MallingAddress) <br />SYocklon CA 95201 <br />ICity, StalZlIpCode) <br />(299) 41+•8438 <br />(Area Code •Telephone Number) <br />stelaloan4@a lobelnot <br />(Small Address) <br />Sketh <br />See attached <br />JOB 0005 REF# <br />APN CRO <br />ENP DATE <br />VALID�� 10 � DRIVE <br />�t<vAYS: <br />STREET eaTa <br />AREA QUAD My "— <br />TYPE — erment&emT p, ofF�afCfosura— <br />FORMS x 7 <br />NOTES Special Conditions <br />'. ROAD CLOSURE FROM WEDNESDAY <br />2022) TH RU FRIDAY (2/11/2022) FROM <br />AM T04:00 PM EACH DAILY, ROAD <br />JED NIGHTLY <br />The undersigned hereby applies for permission to excavate, constructandlor otherwise encroach on County highway rlght•of wayon <br />the rsnmr side of PeeBerd Road approximately 75 IFfeet) Qmile BOA <br />Of Hwy92 by performing the following wol (descriplion of worI <br />rei calved under roed% <br />Work will commerce on or after "I4approximately 2 days. <br />I, To undersigned, candy that I am Iheowner of the respective properly, or am qualified to represent the owner and agree to do the <br />work described above In accordance with the <br />Lid and regulations of San Joaquin County and subject to inspection and approval <br />] +vu rw 1200 <br />5r ura of Applicant - TRIO Date <br />