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PLEASE PRINT: <br />APPLICATION FOR ENCROACHMENT PERMIT <br />Date 111 /2020 <br />To: San Joaquin County <br />Department of Public Works <br />Marcus Moreno <br />(Applicant Name) <br />2020 L Street, Suite 400 <br />(Mailing Address) <br />Sacramento, CA 95811 <br />(City, State, Zip Code) <br />(916) 690-6025 <br />(Area Code •Telephone Number) <br />marcus.moreno6�4aecom.com <br />(Email Address) <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />tpooir REF # <br />CR # <br />(o l 2e <br />Sl <yo TO (o / yo DRIVEWAYS: <br />, VA45 ,EDW a <br />QUAD A <br />weCfS <br />urn/ <br />Sketch (Detailed plans may be submitted) <br />wsrid. Ilk re. Qc Peace sur+• Q.. <br />ct <br />too 390 <br />—:eweThe <br />undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the North side of Paddy Creek approximately s00 feet/mile feet <br />of Jack Tone Road (38.0941881-121.150799 , by performing the following work (description of work): <br />The Department ofMIer Resources (DNR) is [Beggaring and cleaning pipelines crossing beneath 99 Franklin Road. Clearera and inlocrectian of all eligible pipe crossings will be ceMuded by a contractor, <br />Marcel Ripalioa Be . pg np work a M condition of to a p offirc, drjdr�nipPMqnr and synhistrwi whh a vidAn impaction prefordand by Nnd%.n I panel np qPNIrAq no donation procAm <br />requires a Flydrovac cleaning truck and a heavy uty water truck. no video inspection renders of an unmanned camera that WAIT be insaded Into the cleaned crossing. Awmmemialvan Wall be needed to braggart <br />the Inspection rabripment. Thetas no penetration or gsketring of the mad marshal lis wars x111 require a single lane closure for 4 hours. The lane closure area will span 400 feet around the pipe location <br />(as drawn on work Me plan below). Vehicles used to bang the equipment Will be parked in safe areas, on the shouMer, or conableteN off the road. Appropriate flagmen will be used during the deaning and Inspection. <br />A Net descaption of the work and traffic central plan is shown belmW. Maps of each area are allaphW Wath this Ma"t and harbors for traffic control dratwtll be utilized. The purpose of this work Is to host DNR in <br />Work will commence on or after <br />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 />Digitally signed by Moreno, Marcus A <br />DN: cn=Moreno, Marcus A, ou=USSCR2 <br />Date: 2020.05.11 11:38:26 5/11/2020 <br />-07'00' <br />Signature of Applicant • Title <br />Y:IFDRM56TEMPIATE9IMIROFDHMENf read PnPLI(nialso(M) <br />Date <br />