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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3/23/23 <br />To: San Joaquin County <br />Department of Public Works <br />Anthony vice <br />(Applicant Name) <br />265 Lincoln Center <br />(Mailing Address) <br />Stoclaon, CA 95207 <br />(City, State, Zip Code) <br />(209) 625 5275 <br />(Area Code - Telephone Number) <br />tony@feetfeetstoclaon com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREETee <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />110005 REF # <br />CR # <br />TO 6/11/2023 DRIVEWAYS: <br />iffier. . DesomeM��.— <br />Lodi QUAD NVV <br />Temp. Road Closure <br />----- <br />Special Conditions <br />Running event from M2 winery going down Peltier Road to Des Moines Road turning around just <br />before Acampo Road and return back to winery. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the north and south side E. Peltier road and Des Moines Road approximately 15 ®feet/ mile n—antl soNM1 <br />ofE Peltier Road and Des Me nes RoadE`0 a, �aha.MO—Fold by performing the following work (description of work): <br />Running event from M2 winery going down Peltier Road to Des Moines Road turning arch ndjust before Acampo Road an d return back to winery. <br />Work will commence on or after 6/11/23 for approximately— — 15hours_ _ 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 />10 <br />Signature pplicant-Title <br />32323 <br />Date <br />