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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 5/30/23 <br />To: San Joaquin County <br />Department of Public Works <br />Teichert Construction <br />(Applicant Name) <br />265 Val Dervin Pkwy <br />(Mailing Address) <br />Stockton, CA 95206 <br />(City, State, Zip Code) <br />(209) 983-2300 <br />(Area Code - Telephone Number) <br />ralexander@teichert.com <br />(Email Address) <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />STREET Airport Way <br />AREA Stockton QUAD <br />TYPE Temp Road Closure <br />FORMS <br />NOTES <br />***South Airport Way to be closed in <br />multiple phases that run concurrently with <br />each other, starting Wednesday (6/14/2023) <br />at 6:30 AM through Friday (6/30/2023) at <br />5:00 PM*** <br />Sketch (Detailed plans may be submitted) <br />Please see attached plans. Plans have been approved by City of Stockton. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the NB/SB side of S Airport Way approximately 2000 Q feet/ Q mile south <br />of intersection of Performance Dr S Airport Way , by performing the following work (description of work): <br />repair utilities, grading, and paving. <br />Work will commence on or after 6/14/23 for approximately %.. 17 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 />II <br />Signature of Applicant - Title <br />6/6/23 <br />Date <br />