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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 04121/202Q <br />To: San Joaquin County <br />Department of Public Works <br />Woodbridge Irrigation District <br />(Applicant Name) <br />PO Box 580 <br />Address) <br />Woodbridge, CA, 95256 <br />(City, State, Zip Code) <br />209 625 8438 <br />(Area Code - Telephone Number) <br />widversteeg@gmail.com <br />(Email Address) <br />i (Detailed plans may be submitted) <br />�Dc VRIGS Rt? <br />1ti <br />YO'OF 18"CA5;1"6 <br />D/pE ,r' gELo�✓ ROAD <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the under side of oeydes Rd. approximately vz feetl[n f�i Nortn <br />of Woodbddge Rd. Lodi/ U by performing the following work (description of work): <br />Boring under the road to install 40' of 15" 100psi PIP PVC encased in 18" steel pipe. The bore pit and boring machine will be off the <br />county right of way on both sides of the road. No traffic control will be required. The top of the pipe will be 5 feet below the crown of the <br />road <br />Work will commence on or after os/o5/zozo for approximately z days. <br />I, the undersigned, certify that I am the owner of the respective property, <br />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,M0. &lEM%AIESENMAMWNiMWff FPRIGIIONdx(0W <br />OFFICE USE ONLY <br />JOB # <br />REF # <br />APN <br />CR # <br />EXP. DATE <br />3G <br />VALID <br />20 �T6 671116 DRIVEWAYS: <br />STREET <br />AREA <br />ES <br />Di QUAD <br />TYPE <br />FORMS <br />x ?1f <br />NOTES <br />A� AL/.�korrj akX ' <br />��12� FI.Ju iP+�E.t)T GUT' <br />o dE�lf,Lrr�� Nal= <br />i (Detailed plans may be submitted) <br />�Dc VRIGS Rt? <br />1ti <br />YO'OF 18"CA5;1"6 <br />D/pE ,r' gELo�✓ ROAD <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the under side of oeydes Rd. approximately vz feetl[n f�i Nortn <br />of Woodbddge Rd. Lodi/ U by performing the following work (description of work): <br />Boring under the road to install 40' of 15" 100psi PIP PVC encased in 18" steel pipe. The bore pit and boring machine will be off the <br />county right of way on both sides of the road. No traffic control will be required. The top of the pipe will be 5 feet below the crown of the <br />road <br />Work will commence on or after os/o5/zozo for approximately z days. <br />I, the undersigned, certify that I am the owner of the respective property, <br />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,M0. &lEM%AIESENMAMWNiMWff FPRIGIIONdx(0W <br />