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APPLICATION FOR ENCROACHMENT PERMIT PLEASE PRINT: Date 12/03/2019 To: San Joaquin County Department of Public Works Nate Benedict (Applicant Name) 7000 East Avenue, Building 551 E (Mailing Address) Livermore, CA, 94550 (City, State, Zip Code) (925) 423-2085 (Area Code -Telephone Number) benedict7@llnl.gov (Email Address) Sketch (Detailed plans may be submitted) See attached plans OFFICE USE ONLY JOB# //~ REF# APN CR# EXP.DATE VALID DRIVEWAYS: STREET AREA t::,, TYPE s, '", '6t-'4«~ ~ FORMS ~ 1/1hd-.u:1. NOTES ,, The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on the south side of Corral Hollow Road approximately 1000 / 700 Wmile west/ east of 15999 Corral Hollow Road , Tracy, CA , by performing the following work (¥scription of work): installation of solar powered vehicle feedback display signs (2) and installation of surface mounted delineators (11) J I I J Work will commence on or after 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 work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. Signature of Applicant -Title Date Y:IFORMS & TEMPLATESIENCROACHMENT PERMrT APPLICATION.doc (08108)