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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 6/22/2021 <br />To: San Joaquin County <br />Department of Public Works <br />Francisco Salcedo - Knife River Construction <br />(Applicant Name) <br />755 West Clay Street <br />(Mailing Address) <br />Stockton, CA, 95206 <br />(City, State, Zip Code) <br />209 - 395 - 7662 <br />(Area Code - Telephone Number) <br />fmncisco.salcedo@knifedver.com <br />Sketch (Detailed plans may be submitted) <br />Attached <br />JOB # 110005 REF # <br />APN CR # <br />EXP.DATE <br />VALID TO DRIVEWAYS: <br />STREET HarneyLIE <br />AREA Lodi QUAD NVV <br />TYPE Trench & Temp Road Closure <br />FORMS SSAVyV, R-29, Trench Cut Policy <br />NOTES Special Conditions <br />***County Portion of Harney Lane ("0 <br />Lower Sacramento Rd.) will be closed from <br />July 6, 2021 from 7:00 AM to July 16, 2021 to <br />5:00 PM (24 -HR Closure)****** <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way <br />on Harney Lane West of Lower Sacramento Road, by performing the following work (description of work): Road work consisting of <br />Sanitary Sewer Installation and Trench Patching. Duration of work will be 25 days, start date is 7/6/2021. Phase 1 will be a totoal <br />of 7 days, phase 2 will be a total of 3 days, phase 3 will be a total of 3 days, phase 4 will be a total of 2 days, phase 5 will be a total <br />of 8 days. <br />Phase 1 & 2 - 10 days total for 24HR closure (E/S of Lower Sacramento Road - County right-of-way) <br />(W/S of Lower Sacramento Road - City right-of-way) <br />Work will commence on or after 7/6/2021 for approximately twenty-five 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 />rte" Project Manager <br />Signature of Applicant - Title <br />r�wAAS&TEAAmESEHOA000AArrR PERMIT AAPLIC91ONd,, 0AAA <br />6/22/2021 <br />Date <br />