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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OCTOBER 20, 2010 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN <br /> SOUTH SAN JOAQUIN IRRIGATION DISTRICT EXP_DATE CR# <br /> MCR ENGINEERING — DAN EAVENSON <br /> VALID It i o T l it DRIVEWAYS: <br /> (Applicant Name) STREET , <br /> O <br /> AREA £Scq QUAD <br /> 11011 EAST HIGHWAY 120 TYPE ,t e <br /> e. <br /> (Mailing Address) FORMS 9 <br /> C W 2 <br /> 1 e" <br /> MANTECA, CA 95:536 NOTE) <br /> (City, State,Zip Code) <br /> 209) 249-4617 <br /> (Area Code Telephone Number) <br /> Sketch(Detailed pians may be submitted) E <br /> '` RIGHT-OF-WAY <br /> ♦ ENCROACHMENT <br /> g��, PROPOSED ROSSIER RD <br /> N o RR _in E 615 PIPELINE <br /> o¢ o REPLACEMENT o �� <br /> � a <br /> O w > <br /> ZI z ELI <br /> w <br /> Z O <br /> HIGHWAY 12Qc i � i z U <br /> w > <br /> The undersigned hereby applies for permission to excavate,construct andJor oth <br /> the EAST & WEST side of HENRY ROAD erwise encroach on County Highway Right-of-Way on <br /> ofSTATE HIGHWAY 120 approximately 4,400 feet NORTH <br /> IN RURAL SCALON ,by performing the Blowing work(description of ywrk): <br /> REMOVE EXISTING SSJID 36" IRRIGATION LATERAL B15 WITHIN THE COUNTY RIGHT-OF-WAY & <br /> CLASS IV IRRIGATION PIPELINE. PROF'QSED PIPELINE WILL COREPLACE WITH 36" RGRCP <br /> NNECT TO EXISTING SSJID CONTROL STRUCTURE <br /> OUTSIDE OF THE RIGHT-OF-WAY. <br /> J <br /> Work will commence on or about NOVEMBER, 2010 <br /> for approximately 60 <br /> days. <br /> i, the under4ned,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 /> f� �f 1KGIt ! <br /> 9tv- <br /> esr Qcf t Zo/o <br /> Signature of Applicant-Title <br /> Date <br /> _;;55..'n1pSE%t>at?1FYh 3t:F1.T.l�i:.',31i:f�.!C.,z,vcs:. r,•.�� <br />