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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To: San Joaquin County 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 County Highway Right-of-Way 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 />Y:\FORMS & TEMPLATES\ENCROACHMENT PERMIT APPLICATION.doc (08/08) <br />10-27-2021 <br />Barbour Well, Inc <br />260 Sunpac Ave., Suite A <br />Henderson, NV 89011 <br />702-558-5373 <br />szarcone@barbourwell.com <br />2605 Cherokee Rd. (Corner of Cherokee & Robindale Ave), Stockton, CA 95205 <br />North Robindale Ave <br />Corner of Robindale Ave & Cherokee Rd. , Stockton, CA <br />Pumping raw well water into storm drain for test pumping. Initially, between 100-200 gpm If Test Pumping required, the flow could <br />be up to 1000 gpm in (2) 12 hour allotments. Total Time required approx 4 days. <br />total project consists of installation of a well liner and test pumping. <br />Nov 1, 2012 <br />60 days (4 required for encroachment) <br />Ropes and cones to be used to block access to storm drains and <br />flexible above ground piping to be used to transport water. <br />10-27-2021