Laserfiche WebLink
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 /> <br />(City, State, Zip Code) <br /> <br />(Area Code - Telephone Number) <br /> <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 /> <br /> <br /> <br /> <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 />East Bay Municipal Utility District <br />1804 W. Main St. <br />Stockton, CA 95203 <br />(209) 946-8009 <br />douglas.hooper@ebmud.com <br />See attached plans <br />various various variousvarious roads <br />East Bay Municipal Utility District (EBMUD) operates a 72-inch raw water transmission pipeline from Clay Station Road to <br />Cord Road, terminating at the EBMUD Mokelumne Aqueducts. On a periodic and/or emergency basis, EBMUD will perform <br />operations and maintenance, inspections, and monitoring of pipeline appurtenances such as valves, vaults, and cathodic <br />protection systems. EBMUD staff will need to access vaults and other appurtenances along various roads and shoulders. <br />various roads various <br />various 1 hour - 5 days <br />Assistant Superintendent <br />of Aqueduct <br />12/22/2020 <br />12/22/2020