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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 228/23 <br />To: San Joaquin County <br />Department of Public Works <br />Goodfellow Bros CA, LLC <br />(Applicant Name) <br />50 Contractors St <br />(Mailing Address) <br />Livermore, CA 94551 <br />(City, State, Zip Code) <br />(916)584-3483 <br />(Area Code - Telephone Number) <br />thomask@goodfellowbms. com <br />(Email Address) <br />may <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP.DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <br />Please see attached traffic control plans showing traffic control signage encroaching up to 2000' into <br />County RM/ on Corral Hollow Rd. <br />The undersigned hereby applies for permissions to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the side of approximately & feet/ &mile <br />of 1580 _ Corral Hollow Rd by performing the following work (description of work): <br />installation and maintenance oftraffic control devices including delineators and signage. <br />Work will commence on or after 3/13/23 for approximately 180 working 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 />Thomas KakuLnioom.i—'ALmFxnom. <br />Signature of Applicant -Title <br />228/23 <br />Date <br />