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APPLICATION FOR ENCROACHMENT PERMIT <br />DI CACG DDI\IT- <br />Date February 5, 2024 <br />To: San Joaquin County <br />Department of Public Works <br />City of Lodi, Teri Mangrich <br />(Applicant Name) <br />221 W. Pine Street <br />(Mailing Address) <br />Lodi, CA 95240 <br />(City, State, Zip Code) <br />209-269-4910 <br />(Area Code - Telephone Number) <br />tmangrich@lodi.gov <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />See attached Exhibit <br />OFFICE USE ONLY <br />JOB # 110005 REF # <br />APN <br />CR # <br />EXP.DATE <br />VALID <br />2/14/2024 TO 3/1/2024 <br />STREET <br />Harney Ln <br />AREA <br />Lodi QUAD <br />TYPE <br />Sign Install <br />FORMS <br />SS/WW <br />NOTES <br />Special Conditions <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 south side of Harney Lane approximately 40 feet/mile east <br />of Lower Sacramento Road by performing the following work (description of work): <br />install a new 36" x 36" W8-18, Road May Flood, sign on a new post per resident request. See attached exhibit and <br />traffic control plan. USA area prior to digging for the installation of the new post. <br />Work will commence on or after February 14, 2024 <br />for approximately 1 <br />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 />r `Gr) r 1 n 2Ch c'g5'n 2.1175 f 202 <br />Sign ure Applicant - tle Date <br />Y (FORMS & TEMPLATESENCROACNMENT PERMIT APPLICATION da (08108) <br />