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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 6/1/23 <br />To: San Joaquin County <br />Department of Public Works <br />RoadSafe Traffic Systems <br />(Applicant Name) <br />PO Box 1270 <br />(Mailing Address) <br />Verdi, NV 89439 <br />(City, State, Zip Code) <br />(775) 622-2950 <br />(Area Code - Telephone Number) <br />bstahI@roadsafetraffic.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />Please see attached TCP. <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 />6/20/2023 TO 8/20/2023 DRIVEWAYS: <br />Sexton Rd. <br />Escalon QUAD SE <br />Traffic Control Devices <br />--- <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the NB/ s6 side of sexton Rd. approximately 44 _ Q feet/ Q mile <br />of Yosemite Ave. at the Railroad Tracks , by performing the following work (description of work): <br />Flagging operations for the replace and repairs of the signals at the Railroad Tracks. Advance Warning signage and <br />flagging operations only within the county right of way. No full cloures. <br />Work will commence on or after 6/20/23 <br />for approximately <br />2 <br />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 />6/1/23 <br />Signatur f Applicant - Title <br />Date <br />