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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To: San Joaquin County 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 County Highway Right-of-Way 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 />Y:\FORMS & TEMPLATES\ENCROACHMENT PERMIT APPLICATION.doc (08/08) <br />4/16/2021 <br />Mountain F Enterprises, Inc. <br />950 Iron Point Rd, Ste 210 <br />Folsom, CA 95630 <br />530-957-7506 <br />kfb@mtfent.com <br />North Bethany Rd 0 North <br />San Jose Rd <br />MFE has been assigned 3 trims along Bethany road @ 14771, north side of road (east traffic), across from San Jose Rd in Tracy. MFE Traffic Division will perform TCP, T13 with reversable controls. Work will be completed <br />utilizing a lift truck. All brush will be chipped and hauled from site. Estimated working time will be 1 full day. <br />4/26/2021 1 <br />South Transmission Project Manager 4/16/2021 <br />TCP attached <br /> Katelyn Butler <br /> west