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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 Date <br />ed above in accordance w <br />TOPOGRAPHIC SURVEY AT THE INTERSECTION OF NORTH PERSHING AVENUE & COUNTRY CLUB BOULEVARD APPROXIMATELY <br />400' FEET IN EACH DIRECTION WITH 50 FOOT CROSS SECTIONS LIMITED TO BACK OF SIDEWALK TO BACK OF SIDEWALK. <br />SEE ATTACHED PLAN. <br />(209) - 476 - 0011 <br /> 10 - 10 - 2022 14 <br />9/28/22 <br /> ZACHARY WONG - WONG ENGINEERS, INC. <br /> 4719 QUAIL LAKES DRIVE, SUITE G PMB 337 <br /> STOCKTON, CA, 95207 <br /> admin@wongengineers.com <br />EAST N. PERSHING AVE. & COUNTRY CLUB BLVD.400 <br />N. PERSHING AVE. & COUNTRY CLUB BLVD.STOCKTON, CA <br />9/30/22