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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date September 22, 2011 OFFICE USE ONLY <br /> To: San Joaquin County JOB# f/9aa5 - REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Ross Island S and & Gravel Co. VALID o i/ TO 'Z DRIVEWAYS: <br /> (Applicant Name) STREET WP. <br /> AREA QUAD W <br /> P.O. Box 82249 TYPE <br /> (Mailing Address) FORMS S /AIrat/ -L`I <br /> NOTES <br /> Portland, OR 97282-0249 <br /> (City,State,Zip Code) <br /> Cell Office <br /> ( 503) 314-3348 / ( 209 ) 933-0609 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Perform trench cut of Windmill Cove Road as previouslynpermitted <br /> by San Joaquin County Permit No. PS-1002537. Work was permitted <br /> and not performed due to lack of federal funding by US Army Corps <br /> of Engineers. <br /> See Previous Permit (attached) <br /> Renewed levee encroachment permit from Reclamation District No. 684 <br /> has been obtained. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the across giWindmill Cove Road approximately 930 linear feet(rfil6 East <br /> of intersection w/ N. Holt Rd. , Stockton,CA,by performing the following work(description of work): <br /> Saw-cut road where previously patched from previous dredging projects. <br /> Excavate road base & Common Materials. Install HDPE pipe. Cover pipe per <br /> county specification for typical trench backfills. Gravel Patch for. 2 (two) <br /> days of dredging, then remove pipe, fill per spec and Hot-patch Windmill <br /> Cove Rd to prior condition See also attached traffic plan. <br /> Work will commence on or about October 6 , 2011 (Thurs- ) for approximately 2hrs each phase dagsc <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 /> September 22, 2011 <br /> Signature of Applicant-Title Randall H. Steed Date <br /> Dredge Project Manager <br /> E:IPU&SVWKIMASTERPSIENCROACHMENTPERMITAPPUCATION.DOC (DIM) <br />