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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date May 7, 2021 <br />To: San Joaquin County <br />Department of Public Works <br />Aaron Terry, Sr. Manager, Real Estate <br />(Applicant Name) <br />2 Westbrook Corporate Center, 10th Floor <br />(Mailing Address) <br />Westchester, IL 60154 <br />(City, State, Zip Code) <br />312-415-0219 <br />(Area Code - Telephone Number) <br />aaron.teny@iaai.com <br />(Email Address) <br />Sketch (Detailed plans may b <br />Detailed Plans are being <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 />3/1/2023 <br />10/3/2022 To 3/1/2023 DRIVEWAYS: <br />Newton Road ' <br />Stockton QUAD NW ' <br />Road widening & streelights ' <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the West side of Newlon Road approximately 1.900 n feettmile <br />of pavement widening to add travel lane per COA for PAlWO197 by performing the following work (description of work): <br />See attached plans. Roadwidening includes pavement for travel lane and shoulder, striping, drainage ditch, street lights <br />Road widening requires removal of existina trees. <br />Work will commence on or after Oct 1,2921 for approximately, 60 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_ <br />j ,( y Sr. Manager, Real Estate May4,2021 <br />Signature of Applicant -Title Data <br />