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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 31 August 2023 <br />To: San Joaquin County <br />Department of Public Works <br />Railworks Track <br />(Applicant Name) <br />212 Industrial Drive <br />(Mailing Address) <br />CA 95206 <br />(City, State, Zip Code) <br />209-983-0708 <br />(Area Code - Telephone Number) <br />timothy.reynolds@railworks.com <br />(Email Address) <br />may <br />Attached Traffic Control Plan shows affected area. <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 />11/13/2023 TO DRIVEWAYS: <br />raFa RcT <br />btockton QUAD NE <br />Temp Road Closure <br />SSfWW <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 entire width side of Arata Road approximately directly adjacent feet/mile <br />of Baldwin Lane , by performing the following work (description of work): <br />Work will commence on or after TBD for approximately two 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 />j7%/�¢c�rte�2 Project Engineer 31 August 2023 <br />Signature of Applicant - Title Date <br />V]FORMS&TENPIATEIENCROACHMEN T PERMIT APPLICATION dov(W&OP <br />