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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/25/22 <br />To: San Joaquin County <br />Department of Public Works <br />Tim Paxin's Pacific Excavation Inc. <br />(Applicant Name) <br />9796 Kent Street <br />(Mailing Address) <br />Elk Grove, CA, 95624 <br />(City, State, Zip Code) <br />(916) 686-2800 <br />(Area Code - Telephone Number) <br />peyton@pacificexcavation.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />See attached project plans <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 />6/27/2022 TO 11/15/2022 DRIVEWAYS: <br />Airport Way <br />Stockton QUAD SE <br />Trench <br />SS/WW, R-29, Trench Cut Policy <br />Special Conditions <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the __--intersection — -- side of ____Airport Way & Tidewater Crossing Access (New Road) --- approximately ________ 1.5 0 feet/ q) mile to the intersection <br />---------------------------------- <br />of M—� -----Airport Way & Sperry Rd — ---Y-- by performing the following work (description of work): <br />installation of traffic signal and signal interconnect, per attached plans <br />Work will commence on or after ____—N---- 3"'22—for approximately __ TBD____ days. <br />I,e , certify that I am the owner of the respective property, or am qualified to representthe owner and agree to do the <br />w rk a ve in accordance with the rules and regulations of San Joaquin County and subjectto inspection and approval. <br />TVVJ <br />ignature of Applicant - Title <br />2/25/22 <br />Date <br />