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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 04/21/2020 <br />To: San Joaquin County <br />Department of Public Works <br />Woodbridge Irrigation District <br />(Applicant Name) <br />PO Box 580 <br />(Mailing Address) <br />Woodbridge, CA, 95258 <br />(City, State, Zip Code) <br />209 625 8438 <br />(Area Code • Telephone Number) <br />widversteeg@gmail.com <br />(Email Address) <br />Ich (Detailed plans may be submitted) <br />1/� I RAy au <br />�8'57L"EL G�SiN� QItOE S OL -Lo u� Ro�D <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County High�wa Right -of -Way on <br />t <br />Ray IL44JD��' South he under side of Rd. approximately aoo lle <br />of Sargent 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 <br />OFFICE USE ONLY <br />JOB # <br />// REF # <br />APIN <br />CR # <br />EXP. DATE <br />/a/140 <br />VALID <br />7 TO 1 zo DRIVEWAYS: <br />STREETCp. <br />R <br />AREA <br />QUAD <br />TYPE <br />FORMS <br />,e 21 <br />NOTES <br />GAL 4ce4v 1 ws <br />WICA6Apr <br />�zPUil4ubVr LS�5rbE' <br />R/!4/+r-bF-�✓r4✓ <br />,.�,ti7P.t77� uC R.'vCE � <br />Ich (Detailed plans may be submitted) <br />1/� I RAy au <br />�8'57L"EL G�SiN� QItOE S OL -Lo u� Ro�D <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County High�wa Right -of -Way on <br />t <br />Ray IL44JD��' South he under side of Rd. approximately aoo lle <br />of Sargent 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 <br />right of way on both sides of the road. <br />No traffic control will be required. <br />The top <br />of the pipe will be 5 feet below the crown of the <br />road. <br />Work will commence on or atter`o5/onzo2o for approximately z 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 />.:MW:�MWNMWHWW KWaMM,b (�) <br />