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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/14/23 <br />To: San Joaquin County <br />Department of Public Works <br />Eric DeAnda <br />(Applicant Name) <br />909 W Soule St <br />(Mailing Address) <br />West Sacramento 95691 <br />(City, State, Zip Code) <br />(385) 377-0017 <br />(Area Code - Telephone Number) <br />edeanda@discoveryhydrovac.com <br />(Email Address) <br />may <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 />TO DRIVEWAYS: <br />Airport Way & French Camp Rd. <br />Stockton QUAD SE <br />o o es & (1) Core STS <br />SSIVi R-29, Trench Cut Policy <br />Special Conditions <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 French Camp Rd approximately 25' @ feet/ 0mile <br />of Airport way I , by performing the following work (description of work): <br />Discovery Hydrovac will be Hydro Excavating 1 pothole along the north side of French Camp Rd and 1 more on the East side of Airport Way <br />t, i and identify end „dib, Mi Maen9 it,Teter of2P,th, ey (Ay edl b,, ne 4 1 A mmysmwa wt4,n the oo.mv right oi bi S Acg,ft Wye R Fen,, Cam4 Rd.The ... i ma44mmmMaw, 6 rem enter he ) — <br />Work will commence on or after 3/28/23 for approximately 4 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 />EPIC DeAnda p�Z128a�i208ieIDt2i4800 3/14/23 <br />Signature of Applicant - Title <br />Date <br />