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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 1/16/24 <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, 93721 <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 />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />110005 REF # <br />CR # <br />1/30/24 TO 4/30/24 DRIVEWAYS: <br />Durham Ferry Rd. & Linne Rd. <br />Tracy QUAD <br />Traffic Control Devices <br />SSANVV <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 SOUTH side of DURHAM FERRY RD. approximately 240 @ feet/ 0Mile EAST <br />of S KOSER RD, _ , by performing the following work (description of work): <br />TCP NEEDED FOR SHOULDER CLOSURE ON w LINNE RD. TO ACCESS MH 8268, SHOULDER CLOSURE TO ACCESS SB#1047 AND AERIAL PLACEMENT ON DURHAM FERRY RD. <br />Work will commence on or after 1/30/24 for approximately 6 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 />1/16/24 <br />Signature of Applicant - Title <br />Date <br />