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PLEASE PRINT: <br />APPLICATION FOR ENCROACHMENT PERMIT <br />Date 05/11 /2020 <br />To: an 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.morenoaaecom.com <br />(Email Address) <br />Sketch (Detailed plans may <br />�a- <br />1 <br />w.el k <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />//ow REF # <br />CR # <br />(o t 3s <br />S2fya 0 / 26 DRIVEWAYS: <br />116AI kYrA" aezD>WEST <br />/,ODS QUAD AA;l <br />F G sartAa /CES <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the North side of Bear Creek approximately 800 feetlmile feet <br />of 99 Frontage Road (38.061350, -121.259279) , by performing the following work (description of work): <br />The Department of Water Resources (OWR) Is preparing and cleaning pipelines crossing beneath gg Frontage Road. Cleaning and InpseGdon of all efgible pipe crossings will be cenduGed by a connector, <br />regWres a Hydrovac Gearing truck aid a heavy by waterbuck The video inspection consists of an unmanned camera Mat *11 he inserted Into the cleaned crosdrg. A mmnardal ran will be needed to transport <br />the Insparden equipment. ere is no penetration or eslunana of the road protons. This work will require a sing le lana closure for 4 boom. The lane closure area will span Ogg feet around Me pipe happen <br />(as drown on work the plan below). Vehicles used to bring the equipment wlI be parked In safe areas, on the shoulder, or completely off the road. Appmpnate gagmen wall be used dud ng the cleaning and hopes d en. <br />A hdefdesc ipdon of the work and traffic control poen is shown below. Maps of each area are attached with We pemit and methods for tmfficconirol that will he utilized. The pumose of this work Is to assnum in <br />reducling dead risk associated wilh leveff don owntraflons. <br />Work will commence on or after 5/25/2020 for approximately 1-3 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 11:37:38 -07'00' 5/11/2020 <br />Signature of Applicant - Title Date <br />YIFORMSdiEMPUTE5FNCROACHd£MPERMIT APPLICAiION dm(r&b0) <br />