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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 6/1 U/23 <br />To: San Joaquin County <br />Department of Public Works <br />Anthonv Romero <br />(Applicant Name) <br />3U Main Ave, 5ulte b <br />(Mailing Address) <br />Sacramento. UA 9b636 <br />(City, State, Zip Code) <br />(91(5) 164-4412 <br />(Area Code - Telephone Number) <br />aromero(a)wasac.com <br />(Email Address) <br />may <br />Please see attached PG&E drawing. <br />The undersigned hereby applies for permission to excz <br />the NOrth side of Hianwa\ <br />of Drooertv line Ott HVVY99 <br />SOW: Trench for conduit path, install conduit, and backfill for a total length of 2' <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 />9/1/2023 TO 3/1/2024 DRIVEWAYS: <br />Hwy 99 Frontage Rd. <br />Stockton QUAD SE <br />Trench (dirt shoulder) <br />SS/VM/ R-99 <br />Special Conditions <br />construct and/or otherwise encroach on County highway right-of-way on <br />_ approximately 2 @ feet/ 0mile <br />OCKton , by performing the following work (description of work): <br />Work will commence on or after U14 1140 for approximately I 1111J1M1a 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 />Anthony Romero L:-_;_,--- 6/11/23 <br />Signature of Applicant - Title Date <br />