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APPLICATION FORE NCROACHMENTPERMIT <br />PLEASE PRINT: <br />Date 4/17/2020 <br />To: San Joaquin County <br />Department of Public Worts <br />Adam Merrill <br />(Applicant Name) <br />3428 Brookside Rd. <br />(Mailing Address) <br />Stockton, CA, 93401 <br />(City, State, Zip Code) <br />(209) 943-2021 <br />(Area Code -Telephone Number) <br />amerril I @siegfriedeng. com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />See attached Improvement Plans. <br />JOB <br />APN <br />EXP.DAIE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />110005 FEE <br />CRp <br />07/012021 <br />01/01/2021 TO 07/012021 DRIVEWAYS'. <br />Kasson Rd <br />Tracy QUAD SIN <br />rl Ivewm,Dron <br />gCNVN/ per oved plans lattacbed) <br />The undersigned hereby applies for permission to excavate, construct anNor otherwise encroach on County Highway Right of Way on <br />the North side of Kasson Road approximately 305 feet/mile feet <br />of native soil by performing the following work(description of woB). <br />grading and construction of a concrete truck yard driveway. <br />Work will commence on or after 5/01/2020 for approximately 60 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 ruled and regulations of Sen Joaquin County and subject to inspection and approval. <br />-Principal, PE 4/17/2020 <br />Signature of Applicant - Title Date <br />