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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 05/14/2018 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 110005 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Arcadis U.S.,Inc.(contact:Sherrie Lang) VALID U TO I j DRIVEWAYS: <br /> (Applicant Name) STREET /�--1�p Pass �Po1 <br /> AREAQUAD <br /> 101 Creekside Ridge Court,Suite 200 TYPE <br /> (Mailing Address) FORMS (lj / =:2 c>f <br /> NOTES <br /> Roseville,CA 95678 <br /> (City,State,Zip Code) <br /> 916-865-3171 <br /> (Area Code-Telephone Number) <br /> sherrie.lang@arcadis.com <br /> (Email Address) <br /> Sketch(Detailed plans may be submitted) <br /> See attached plan.Note that the attached Traffic Control Plan was created for B-51 and the attached CA MUTCD will <br /> be referenced for B-52. <br /> The undersigned hereby applies for ppermission to excavate,construct and/or otherwise encroach on County HighwayRight-of-Way on <br /> the south and north side of South Patterson Pass Road approximately 100 d ee ile <br /> of the interstate 580 south-bound off-ramp ,by performing the following work(description of work): <br /> Complete borings B-51 and B-52.See attached plan for details.Note that both borings are vertical. <br /> Work will commence on or after upon permit application approval for approximately two 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 /> 05/17/2018 <br /> Signature of Applicant-Title Date <br /> YVORMS b TEMPLATESIENCROACNMENT PERMIT APPLICATIONADC(08108) <br />