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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br /> <br /> <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br />the North side of Corral Hollow Road approximately 725 feet/mile East <br />of LLNL Main Entrance (15999 Corral Hollow Rd, Tracy, CA ) by performing the following work (description of work): <br />Pothole of existing water line approximately 3’ deep. Excavation not to exceed 24” in diameter <br />Work will commence on or after SJC Approval (ASAP)for approximately 1 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 />Date 2/11/2021 OFFICE USE ONLY <br />To:San Joaquin County JOB # REF # <br />Department of Public Works APN CR # <br />EXP. DATE <br />Blake Brown VALID TO DRIVEWAYS: <br />(Applicant Name)STREET * <br />AREA QUAD * <br />7000 East Avenue TYPE * <br />(Mailing Address)FORMS <br />NOTES <br />Livermore, CA 94550 <br />(City, State, Zip Code) <br />(928) 495-9657 <br />(Area Code - Telephone Number) <br />Brown311@llnl.gov <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />See attached for Corral Hollow TCP