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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 8/15/2023 <br />To: San Joaquin County <br />Department of Public Works <br />Waterloo Morada Firefiqhters Association <br />(Applicant Name) <br />6925 E. Foppiano Ln. <br />(Mailing Address) <br />Stockton, CA. 95212 <br />(City, State, Zip Code) <br />(209) 484-8758 <br />(Area Code - Telephone Number) <br />tsilva@wmfire.org <br />(Email Address) <br />may <br />Please see attatchments. <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 />10/7/2023 TO 10/7/2023 DRIVEWAYS: <br />Various Roads - Morada Area <br />Stockton QUAD M <br />5K Run Event <br />Special Conditions <br />****Temporary <br />Road Closure Controllea Dy umH <br />October 7, 2023 from 7:00 AM to 10:30 AM**** <br />The waterloo Morada Professional Firefighter's Association and the Morada Area Association will be <br />hosting our 5th annual FireK fun run in the Morada area. The run will begin and end at Davis <br />Elementary School on Saturday. October 7. 2023. Event time will be from 0700-1030. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the side of approximately 0feet/ 0mile <br />of , by performing the following work (description of work): <br />5K fun run in Morada area. <br />Work will commence on or after 10/7/2023 for approximately 3-4 hours 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 />/ � � � 8/15/2023 <br />Signature of Applicant - Title Date <br />