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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 7/20/23 <br />To: San Joaquin County <br />Department of Public Works <br />City of Lathrop - Brad Taylor <br />(Applicant Name) <br />390 Towne Centre Drive <br />(Mailing Address) <br />Lathrop, CA, 95330 <br />(City, State, Zip Code) <br />(209) 941-7430 <br />(Area Code - Telephone Number) <br />btaylor@ci.lathrop.ca.us <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 />8/1/23 TO 8/15/23 DRIVEWAYS: <br />Lathrop Rd. <br />Lathrop QUAD sW <br />Restriping & Traffic Control Devices <br />ss/vvvv <br />Striping exhibit provided as separate document <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 Lathrop Road approximately 1500 @ feet/ Qmile west <br />of Airport Way , by performing the following work (description of work): <br />Restdpe westbound approach to the grade separation median to change the trajectory of vehicles in attempt of reducing the number of collisions with the median. <br />Work will commence on or after 8/1/23 for approximately 2 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 />Brad Taylor, P. E. pie20230720008 as Taylor00000 7/20/23 <br />Signature of Applicant - Title <br />Date <br />