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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 11/21/2013 OFFICE USE ONLY <br /> To: San Joaquin County JOB# //pis REF# <br /> Department of Public Works APN CR# <br /> ARCADIS U.S. INC. EXP.DATE r1.4 <br /> VALID Q- 7 TO 6 1 !w DRIVEWAYS: <br /> (Applicant Name) STREET &ew ASS ,60• <br /> 101 Creekside Ridge Ct. Suite 200 AREA ��AGV QUAD 5M)TYPE prr <br /> (Mailing Address) FORMS <br /> Roseville, CA 95678 NOTES <br /> (City,State,Zip Code) <br /> 916-865-3153 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> See detailed plans attached. <br /> "Z4,�.Ait�tiarw4f ice.Nr � �S �£ E r�sr�/f�o - f - /✓;e4 0c,filo <br /> d r lvll a.�iv� �o.tl r7C�2�d/Ey [LS �j.Tf!?/>✓iS r'Er:✓�'llT. <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 Patterson Pass Road approximately 500 feet ile west <br /> of 1-580 , by performing the following work(description of work): <br /> Installation of horizontal drilled piping across and along Patterson Pass Road at approximately 25775 Patterson Pass <br /> Road. One transverse bore completely across the road, one longitudinal bore for approximately 150 feet along the south <br /> shoulder of the road, 5 minor(<1 ft)transverse bores to existing remediation wells located along the south shoulder, and <br /> 1 transverse bore to an existing remediation well located in the center of the southernmost lane.Additional above-grade <br /> piping will cross a service road located south of Patterson Pass Road, which will be contained within a speed bump. <br /> Work will commence on or about April 1, 2014 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 /> �CivilEngineer 11/21/2013 <br /> Signature of Applicant-Title Date <br /> M.ICENTRALSERVICESICLERICALIPUB-SV.WNIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (09/13) <br />