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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 4/6/23 <br />To: San Joaquin County <br />Department of Public Works <br />Cdstina Pedmncelli <br />(Applicant Name) <br />2850 Collier Canyon Road <br />(Mailing Address) <br />Livermore CA 94551 <br />(City, State, Zip Code) <br />(925) 245-8788 <br />(Area Code - Telephone Number) <br />cpedmnceui kiiemright. com <br />(Email Address) <br />may <br />JOB # <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />11005 REF # <br />CR # <br />10/2/23 TO 11/30/23 <br />Schulte & Lammers Road <br />Tracy QUAD <br />Widening, LHT pocket addition <br />SSMM/, R-29, Trench cut policy <br />PS -2301009 <br />DRIVEWAYS: <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the east side of Lammers Road approximately QQ feet/Qmile <br />of south _ Schulte Read by performing the following work (description of work): <br />Work will commence on or after ettt23 for approximately 120 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 />Vuetiw— P�'e"b Project Manager <br />Signature of Applicant - Title <br />04-06-2023 <br />Date <br />