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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 11/28/22 <br />To: San Joaquin County <br />Department of Public Works <br />G&N Construction <br />(Applicant Name) <br />891 N Broadway Ave <br />(Mailing Address) <br />Stockton, CA 95205 <br />(City, State, Zip <br />(209)956-6000 <br />(Area Code - Telephone Number) <br />pgoes@?gandneonstruction.com <br />(Email Address) <br />may be submitted) <br />SEE ATTACHED <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPEre�F— <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />110005 REF # <br />CR # <br />9/20 TO DRIVEWAYS: <br />Cardinal Ave. <br />Stockton QUAD ES <br />renc u o icy <br />Special Conditions <br />****Coordinate with the Elementary School across the Street, in order, <br />not to interfere with the peak hours drop-off and pick-up times**** <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the East side of Cardinal Avenue approximately 800 (�) feeU mile South <br />of Arielle Avenue I Stockton , by performing the following work (description of work): <br />Trenching per SJ County Standard Drawing to install a new 6" sewer service to property <br />will commence on or after December 19th for approximately <br />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 />1141) <br />Sign y <br />ure of Applicant - Title Date <br />