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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 1 April 2013 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID jf T !,5-I� DRIVEWAYS: <br /> City of Tracy Development Services STREET 271, <br /> AREA QUAD <br /> TYPE <br /> 333 Civic Center Drive FORMS 29 <br /> NOTES <br /> Tracy,CA 95376 <br /> 209-831.6454 <br /> See attached <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the West side of Tracy Blvd approximately 1,200 feet from Tracy Water Plant to Delta-Mendota Canal Crossing,by performing the <br /> following work(description of work): <br /> Trench and install approximately 1200 If of 2.5 inch of PVC potable waterline from existing 24 inch ductile iron transmission main at <br /> the entrance to Tracy(John Jones)Water Treatment Plant to existing above ground storage tank at Tracy Police Firearms Practice <br /> Range. Line operating pressure 30 psi maximum,PVC pipe to be 315 psi class with solvent weld fittings. <br /> Work will commence on or about_July 2013_for approximately 30 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��/Vo� 1 April 2013 <br /> Binh Nguyen,Ass date Civil Engineer Date <br /> vvFoRus a TEN PLAn=sEHcROACHMExr Muff aspucnno4ft(Ca" <br />