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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PR;!:/ / <br />Date :) ) 9 '-{ <br />To: San Joaquin County <br />Department of Public Works M;cJ\eb TTT11cble:>5, l11c. ~t~lq2.<1r <br />(Applicant Name) <br />(Mailing Address) <br />6rowl)')v,'l\e .. wl S'3t>ob <br />(City, State, Zip Code) <br />9tl-~o-lf~5~ <br />. \ (Area Cqde\-Telephone Number) <br />0 <\2q r M,c.~{ 7). u~ <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />JOB# <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />t <br />N <br />OFFICE USE ONLY <br />REF# <br />CR# <br />TO DRIVEWAYS: <br />* <br />QUAD * <br />* <br />E KeHle f'1C/\ R~ <br />The unde eby applies for permi§sion to ercavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br />the ~~-c.....;::....::<--side of ~A ~-t ~<tt\e l"\C.f\ L I\ approximately 0 ~e-t-feet/mile w~ st <br />, ----~_____,,--by performin the following w • • work : 1 f~'\ G.r .....!....-1~.......u.!=~=-=-...--l.!::....!.,..._~~~:i........:....:....u:..:.....:.;.:..;~-'----=-~:..:..!....-_1£.L.JI.......J.:..::~~~..,...=..:....-----=--=-~~-=-::::~~l..!l...:.;:.:~I----&-:-:.....,:__.:....,_;.....:.:.!.. <br />-1.!.U~~"'---=-....!....:..:..~~..:........!...-=---..:..:......;....._:......:....._~~~___:._.:~~--!..4-~.i......::.,,L-~~~.i....;_;_;__:~.:...._.....;~_:;,;.=...i=....i.~~~-H-Io o r~ . .t'o~ ~~s....L..!,.,~~--..!J~::u....i::!~"'-4.-~--=~~~~:__:__...:....:.!..:....:..u,:~~~)._L..J..!.!1....,-J....!.!...~:\----=~_.!.:..!:!,...;__::_:,_,!.l-'--=-_..!..:_--1..!..!:::..:..:....._.t......::: <br />Work will commence on or after __ 3'+-/ti_,_,=-~L.t.....__ ________ for approximately ___ o_, -'-S _____ 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 r ance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />• le Date <br />.....,.....,, ,.,..S'cHCROACHt.EHT PERMIT APPUCATIOH,cloo (0&'08) <br />110005 <br />3/21/2024 <br />Kettleman Ln. <br />Traffic Control Devices <br />SS/WW <br />Special Conditions <br />4/21/2024