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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 8/1523 <br />To: San Joaquin County <br />Department of Public Works <br />Tony vice <br />(Applicant Name) <br />265 Lincoln Center <br />(Mailing Address) <br />Stoclaon, CA 95207 <br />(City, State, Zip Code) <br />(209) 625 5275 <br />(Area Code - Telephone Number) <br />tony@feetfeetstoclaon com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />OFFICE USE ONLY <br />JOB # 110005 REF # <br />APN CR # <br />EXP.DATE <br />VALID 11/5/2023 TO 11/5/2023 DRIVEWAYS: <br />STREET Peltier Rd. & Des Moines Rd. <br />AREA Acampo QUAD NVI <br />TYPE Temp. Road Closure <br />FORMS <br />NOTES Special Conditions <br />'-"`5K & 10K on November 5 2023 <br />From 9:OOAM to 10:30AM'-"` <br />Running event from m2 Winery down Peltier Road to Des Moines Road. Turning around just before <br />Acampo Road and heading to winery. - see attached traffic mitigation 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 and south side of E. Peltier road and Des Moines Road approximately 15 0feeV QQ mile noR,/soum <br />of E Peltier Road and Des Menes Road <br />eiteiraoad and Dealer nesRoad by performing the following work (description of work): <br />Running event from m2 Winery down Peltier Road to Des Moines Road. Turning aroundjust before Acampo Road and heading to winery. <br />Work will commence on or after_ — — — 11/5/23— — — _fora approximately 15he— <br />PP Y— 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 />.!Y /LC/GB ' 8/1523 <br />Signatureof plicant-Title <br />