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PLEASE PRINT: APPLICATION FOR ENCROACHMENT PERMIT <br />Date <br />To: San Joaquin County <br />Department of Public Works <br />'51 M 1 LZ GCa^tST�VGn ()tom! <br />(Applicant Name) <br />47-5 >;n►tEFZF�-rct �up�, sy�TE <br />(Mailing Addreaa) <br />40?VT01 C1A <br />(CRY, State, Zip Code) <br />(Area Code - Telephone Number) <br />(Email Addreaa) <br />may <br />ATTACHED S)c• I <br />JOB # <br />110005 <br />REF # <br />APN <br />CR# <br />EXP. DATE <br />— <br />VALID <br />12/12/2022 TO <br />1/15/2023 <br />STREET <br />Cardinal Ave. <br />AREA <br />Stockton QUAD <br />ES <br />TYPE <br />Trench <br />FORMS <br />flS/ VV R-5 R-61 R-29, renc ut <br />NOTES <br />c,.,.,.i-,i r,.. Ai+i— <br />***Contractor to coordinate with the Elementary School across the street, <br />in order, not to interfere with the peak hours for drop-off and pick-up at the <br />school*** <br />DRIVEWAYS: <br />The undersell hereby applies for permission to excavate, constnrct and/or otherwise encroach on County high <br />aide of Cardinal Avenue way dghl-of--way on <br />of + ArdeneAve bdftn approximately 800 e° feeUQmllesmJA <br />Trenching Der SJ Countv standard drawing to Install A .,e by performing the following work (description of work): <br />GA t rn <br />Workwill commence on or after 12 2 <br />forapproximately ao days. <br />1, 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 />• 11.22.2022 <br />Sign of Appliea - e <br />Date <br />