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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3-29-2021 <br />To: San Joaquin County <br />Department of Public Works <br />INVESTMENTS, LLC <br />(Applicant Name) <br />3108 CHERERYLAND AVENUE <br />(Mailing Address) <br />STOCKTON CA 95215 <br />(City, State, Zip Code) <br />(209) 915-0009 <br />(Area Code - Telephone Number) <br />aeorae@vanquardofcalifornia.com <br />(Email Address) <br />plans may be submitted) <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 />03/30/2021 TO 5/15/2021 DRIVEWAYS: <br />Report Ave. <br />Stockton QUAD INS <br />12" Pipe Installation <br />SKETCH IS ATTACHED <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on Count Highway Right -of -Way on <br />the EAST side of REPORTAVENUE approximately 370 FEET feet/mile N/A <br />Of , by performing the following work (description of work): <br />INSTALLING 12" GALVANIZED CORRUGATED STEEL PIPE AND COVERING WITH SOD. <br />Work will commence on or after AS SOON AS PERMIT IS ISSUED for approximately ONE WEEK 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 />I.JeO-ae (56W61a PROPERTY OWNER 3-29-2021 <br />SignaWe of Applicant - Title Date <br />Y WORM S1@MAlEMIf MHWRL ff IA "RDRE ("M <br />