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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 7-12-11 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> Teichert Construction EXP.DATE f !/ <br /> VALID !/ 0 DRIVEWAYS: <br /> (Applicant Name) STREET Lo RD, <br /> P.O. Box 1118 AREA QUAD = <br /> TYPE Tj�' _Lz9AlE GI,054r = <br /> (Mailing Address) FORMS � <br /> Stockton, CA 95201 NOTES <br /> (City,State,Zip Code) <br /> 209-983-2300 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailec plans may be submitted) <br /> Temporary lane closure with flagging as needed to construct <br /> levee maintenance project for RD 2038 at Lower Jones Tract. <br /> See attached CA MUTCD TA-13 and TA-18 to be used as needed. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the Both _side of W. Bacon Island&Lower Jones approximately 5 <br /> Of X&mile <br /> by performing the following work(description of work): <br /> Gra ing and excavating to reinforce and rai a the levee for Reclamation <br /> District 2038 at Lower Jones Tract <br /> Work will commence on or about 01-18-11 for approximately 30 working <br /> 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 /> _&� Brian Knecht - Proiect Engineer 07-12-11 <br /> ature of Applicant-Title Date <br /> E:IPUBSVWKWASTERP51ENCROAC;fIMENTPSZWTAPPUCA7I0N.DOC(01N8) <br />