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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 9/19/23 <br />To: San Joaquin County <br />Department of Public Works <br />HALEY CONTRACTING <br />4228 NEWTON RD. <br />(Applicant Name) <br />(Mailing Address) <br />STOCKTON, CA 95205 <br />(City, State, Zip Code) <br />(209) 463-2517 <br />(Area Code - Telephone Number) <br />gregg@haleycontracting.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <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 />10/9/2023 TO 11/9/2023 DRIVEWAYS: <br />Shaw Rd. <br />Stockton QUAD NS <br />Trench <br />SS/WW, R-29, Trench Cut Policy <br />Special Canditions <br />W,,Shaw Pa'. el�xmlW <br />%Je map__ <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the NORTH side of 1648 N. SHAW RD (in cul-de-sac) approximately 3/4 Q feet/ 0 mile North <br />Of Fremont St. , by performing the following work (description of work): <br />We will tie on to a 6" tap by Cal Water on the west side of the cul-de-sac and install a 6" lateral to the east side of the cul-de-sac and construct <br />Work will commence on or after 9/26/23 for approximately FOUR 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 />• 9/22/23 <br />gnature Applicant - Title Date <br />