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PLEASE PRINT: <br />Date 8/11/23 <br />APPLICATION FOR ENCROACHMENT PERMIT <br />To: San Joaquin County <br />Department of Public Works <br />Bear Electical Solutions <br />(Applicant Name) <br />1252 State St PO box 924 <br />(Mailing Address) <br />Alviso, CA 95002 <br />(City, State, Zip Code) <br />16) 938-1740 <br />(Area Code - Telephone Number) <br />Core.s@bear-electrica I.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />Please see attachment. <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />OFFICE USE ONLY <br />770731 REF # <br />CR # <br />9/5/2023 TO 10/5/2023 DRIVEWAYS: <br />Multiple Locations - See Attached Maps ' <br />AREA <br />TYPE <br />Stockton QUAD LV <br />(2) -Wooden Pole Installs <br />FORMS <br />NOTES <br />SS/WW <br />Special Conditions <br />""County Project - Lincoln Village Water"" <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the Northeast corner side of W Benjamin Holt & Vicksburg Place approximately 40 0 feel] O mile <br />Of the center of the intersection by performing the following work (description of work): <br />Excavating 7' holes to stand wood poles. Back fill with 3/4" crushed rock. This is for San Jaoquin County to mount equipment on. <br />Work will commence on or after 8/11/23 for approximately 5 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 />l �o' e Cf uuavta er 8/11/23 <br />Ignature of Applicant - Title Date <br />ce� sv�- zoti <br />