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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 04/21/2023 <br />To: San Joaquin County <br />Department of Public Works <br />Amaudo Construction <br />(Applicant Name) <br />PO Box 174 <br />(Mailing Address) <br />Tracy, CA 95378 <br />(City, State, Zip Code) <br />(209) 817-4646 <br />(Area Code - Telephone Number) <br />randy.holtberg@amaudoinc.com <br />(Email Address) <br />may <br />See Attached <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 6/1/2023 DRIVEWAYS: <br />Handel Rd. ' <br />Lodi QUAD NE " <br />Trench ' <br />SSA&W, R-29, Trench Cut Policy <br />Special Conditions <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County high -0T -way on <br />the middle side of Handel Road approximately 0.5 fe mile East <br />of Alpine Road , by performing the following work (d on of work): <br />Construct 48" RCP pipeline crossing for North San Joaquin Water Conservation District <br />Work will commence on or after 05/15/2023 for approximately s 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 />(Project Manager) 04-21-2023 <br />Signature of Applicant - Title Date <br />