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STATE OF CALIFORNIA.DEPARTMENT OF TRA I9PORTATIQN <br /> ENCROACHMENT PERMIT <br /> TR-0120(REV.6/2012) 1_ \ + r Permit No. <br /> 1019-NSV-0085 <br /> Dist/Co/Rte/PM <br /> In compliance with(Check one): <br /> San c/u,dr 10-SJ-99-3.15/6.22 <br /> ® Your application of January 30, 2010alrci!01 x`;01 ti `rrr 10-SJ-120-5.13/7.15 <br /> Date <br /> Utility Notice No. of 02/06/2019 <br /> Fee Paid Deposit <br /> Agreement No. of $ $ Exempt <br /> Performance Bond Amount(1) Payment Bond Amount(2) <br /> R/W Contract No. of $ g <br /> Bond Company <br /> Bond Number(1) Bond Number(2) <br /> TO: <br /> San Joaquin Council of Governments <br /> 555 E. Weber Ave <br /> Stockton, CA 95202 <br /> ATTN: David Ripperda <br /> I <br /> TEL : (209) 235-0450 PERMITTEE <br /> I <br /> And subject to the following,PERMISSION IS HEREBY GRANTED to: <br /> Perform civil engineering surveys, design field reviews, environmental field studies and <br /> geotechnical investigations/borings within State Highway 99/120 right of way between Post Mile <br /> 3.12 and 6.22 of Highway 99, and between Post Mile 5.12 and 7.15 of Highway near Manteca, <br /> San Joaquin County. A copy of this permit shall be placed in all vehicles involved in doing this <br /> work. Traffic control shall be as directed by the State representative. <br /> Permittee shall notify the State Representative JOE VALDEZ, (209) 948-3656 or by email: <br /> Jose ph.A.VaIdez(a)dot.ca.gov, P. O. Box 2048 Stockton, CA 95201, SEVEN WORKING DAYS <br /> PRIOR to the start of this work if no traffic controls will be needed to accomplish the permit work. <br /> THIS PERMIT IS NOT A PROPERTY RIGHT AND DOES NOT TRANFER WITH THE PROPERTY TO A NEW OWNER <br /> The following attachments are also included as part of this permit(Check applicable): In addition to fee,the permittee will be billed <br /> actual costs for: <br /> ® Yes ❑ No General Provisions ❑ Yes ® No Review <br /> ❑ Yes ® No Utility Maintenance Provisions ❑ Yes ISI No Inspection <br /> M Yes ❑ No Special Provisions T,TR-400 ❑ Yes ® No Field Work <br /> ❑ Yes ® No A Cal-OSHA permit,if required:Permit No. <br /> ❑ Yes ® No As-Built Plans Submittal Route Slip for Locally Advertised Projects (If any Caltrans effort expended) <br /> ❑ Yes ® No Storm Water Pollution Protection Plan <br /> ❑ Yes ® No The information in the environmental documentation has been reviewed and considered prior to approval of this permit. <br /> This permit is void unless the work is complete before July 31, 2019. <br /> This permit is to be strictly construed and no other work other than specifically mentioned is hereby authorized. <br /> No project work shall be commenced until all other necessary permits and environmental clearances have been obtained. <br /> APPROVED: <br /> Original:Permittee <br /> 2-Joe Valdez <br /> 1-Maintenance <br /> 1-Plo DAN McELHINNEY, Actinci District Director <br /> 1-File <br /> George ELSON MAGSAYO, District P rmit En ineer <br /> ADA NOTICE:For individuals with sensory disabilities,this document is available in alternate formats.For information,call(916)445-1233,TTY 711,or <br /> write to Records and Forms Management, 1120 N Street,MS-89,Sacramento,CA 95814. <br /> 1 of 4 <br />