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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To: San Joaquin County <br />JOB #REF # <br />Department of Public Works APN CR # <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />(Applicant Name)STREET * <br />AREA QUAD * <br />TYPE * <br />(Mailing Address)FORMS <br />NOTES <br />(City, State, Zip Code) <br />(Area Code - Telephone Number) <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on &ounty Kighway ULght-of-Zay on <br />the ______________ side of ___________________________________ approximately ____________ feet/mile _________ <br />of _______________________________________, ____________________, by performing the following work (description of work): <br />Work will commence on or after _____________________________________ for approximately ________________________ 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 />Signature of Applicant - Title Date <br />12/14/21 <br />East Bay Municipal Utility District <br />1804 W. Main St. <br />Stockton, CA 95203 <br />(209) 946-8009 <br />douglas.hooper@ebmud.com <br />See attached plans <br />various various roads various various <br />various roads various <br /> East Bay Municipal Utility District (EBMUD) operates a 72-inch raw water transmission pipeline from Clay Station Road to Cord Road, <br />terminating at the EBMUD Mokelumne Aqueducts. On a periodic and/or emergency basis, EBMUD will perform operations and <br />maintenance, inspections, and monitoring of pipeline appurtenances such as valves, vaults, and cathodic protection systems. <br />EBMUD staff will need access to vaults and other appurtenances along various roads and shoulders. <br />1/1/22 1 hour - 5 days <br />Douglas Hooper Digitally signed by Douglas Hooper <br />Date: 2021.12.14 09:30:24 -08'00'12/14/21