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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 61y23 <br />To: San Joaquin County <br />Department of Public Works <br />ReadSafe Traffic Systems <br />(Applicant Name) <br />PO Box 1270 <br />(Mailing Address) <br />Verdi, NV 89439 <br />(City, State, Zip Code) <br />(]]5) 622-2950 <br />(Area Code - Telephone Number) <br />bstahgloadsafetraffic. com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />Please see attached TCP. <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 />6/20/2023 TO 8/20/2023 DRIVEWAYS: <br />Jack Tone Rd. <br />Stockton QUAD SE <br />Traffic Control Devices <br />SSAVyV <br />Special Conditions <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the _ _ Nef SB _ side of _ — — Jack Tone Rd — _ _ _ approximately _ —45— _ IFfeetl©mile _ <br />of French camp Rd ________ at the Ranaad Taar_s_, by performing the following work (description of work): <br />Flagging operations for the replace and repairs of the signals at the Railroad Tracks Advance Warning signage and <br />flagging operations only within the county right of way. No full cloures. <br />Work will commence on or after_ — — — 6/20/23 _ _ _ _ for approximately— — ?— _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 />a'cuuv�*L �CLG 6,1,23 <br />Signatureo pplicant-Title <br />