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PLEASE PRINT: <br />Date 10/18/20 <br />APPLICATION FOR ENCROACHMENT PERMIT <br />To: San Joaquin County <br />Department of Public Works <br />West Coast Backhoe, Inc <br />(Applicant Name) <br />33 Maxwell St <br />(Mailing Address) <br />Lodi, Ca 95240 <br />(City, State, Zip Code) <br />(203) 339-7394 <br />(Area Code • Telephone Number) <br />timj@_westcoastbackhoe.net <br />(Email Address) <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />110005 <br />10/24/2022 <br />Williams St. <br />OFFICE USE ONLY <br />REF # <br />CR # <br />TO 11/15/2022 DRIVEWAYS: <br />AREA <br />TYPE <br />Stockton <br />Trench <br />QUAD NS <br />FORMS <br />NOTES <br />SSMNV, R-29, Trench Cut Policy <br />Space Condtons <br />Sketch (Detailed plans may be submitted) <br />See Attachment Planswift - Encroachment Plan 9.22.22 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the West side of N.WilliamSt approximately 20© feet/ ® mile <br />of 2' wide x 20' long trench 5' wide x 11' long trench by performing the following work (description of work): <br />Pot Hole, Sawcut, provide shoring box for City of Stockton Crew Access to (E) 12' SS for tap. Install 4" service lateral to property <br />Work will commence on or after 10/19/20 for approximately <br />14 <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 />10/18/20 <br />Signature of Applicant - Title <br />Date <br />