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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 12/4/23 <br />To: San Joaquin County <br />Department of Public Works <br />VALLEY PERMIT DESK <br />(Applicant Name) <br />1445 VAN NESS AVE. <br />(Mailing Address) <br />FRESNO,CA <br />(City, State, Zip Code) <br />(559) 285-4894 <br />(Area Code - Telephone Number) <br />g26977@att.com <br />(Email Address) <br />may <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPEend <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />A020S5x 110005 REF # <br />CR # <br />12/14/2023 TO 1/14/2024 DRIVEWAYS: <br />French Camp Rd <br />French Camp QUAD <br />SS/WW <br />pecial Conditions <br />TCP NEEDED FOR SHOULDER CLOSURE ON FRENCH CAMP RD., S LEO GIRON RD., <br />YETTNER RD. & MANTHEY RD. <br />FOR SB #6001, SB #1, MH #2545 ACCESS, AERIAL PLACEMENT,SOFT CLOSURE ON S LEO <br />GIRON RD. <br />FOR AERIAL CROSSING. RIGHT LANE CLOSURE ON MANTHEY RD. FOR SB #2 ACCESS <br />IGTAC.1Ole] <br />:IGNY��b�il <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the side of approximately 0feet/ 0mile <br />of , by performing the following work (description of work): <br />Work will commence on or after 12/14/23 for approximately 3 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 />Brian E. Schultz pie20233120409009 ai 0800 12/4/23 <br />Signature of Applicant - Title <br />Date <br />