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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OCTOBER 19, 2012 OFFICE USE ONLY <br /> To: San Joaquin County JOB# /lmf-16- REF# <br /> Department of Public Works APN _ CR# <br /> SOUTH SAN JOAQUIN IRRIGATION DISTRICT EXP.DATE <br /> — FORREST KILLINGSWORTH VALID 9021 L TO I 13 DRIVEWAYS: <br /> (Applicant Name) STREET gEiNE6uL�. <br /> AREAQUAD <br /> 11011 EAST HIGHWAY 120 TYPE -rA5,11v 21V41 <br /> (Mailing Address) FORMS Ss w 29 <br /> NOTES <br /> MANTECA, CA 95336 <br /> (City,State,Zip Code) <br /> (209) 249-4620 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) ROW <br /> ENCROACHMENT <br /> EX. LAT. A EX. LAT. A EX. LAT. <br /> ��yqt f IRR LINE IRR LINE B15 <br /> �qD f J IRR LINE <br /> J <br /> w w PROPOSED B15 PROPOSED B15 � <br /> a S IRRIGATION LINE IRRIGATION LINE w¢ N <br /> = OWENS ROAD w <br /> EX. A-178DD DEAD END c~n <br /> IRR LINE IRR LINE <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> !he side ACROSS STEINEGUL ROAD approximately pp y 1,400 teeter NORTH <br /> Of OWENS ROAD by performing the following work(description of work): <br /> INSTALL A 36" R.G.R.C.P. IRRIGATION & DRAINAGE PIPELINE ACROSS STEINEGUL LANE RIGHT—OF—WAY <br /> TO AN ANGLE POINT & POINT OF CONNECTION. THE OVERALL PROJECT <br /> INTENTION IS TO RELOCATE AN EXISTING 4W BOX ALONG THE WEST RIGHT—OF—WAY OF STEINEGUL ROAD <br /> FURTHER WEST TO A BETTER SUITED LOCATION THAT WILL ALLOW THE EXTENSION OF LATERAL B15 TO CONNECT TO <br /> EXISTING LATERAL A178DD (SEE SKETCH). <br /> Work will commence on or about OCTOBER, 2012 for approximately 60 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 /> 4;:�t 10- ASSM14-rf ENbINf�R SOI « � 1Z <br /> Signature of Applicant-Title Date <br /> E UkIC SYV1'.^SIFR.PAr1CKkACHf4JN I PERMT APPUC.ATKIN V X tl l) <br />