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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 5/3/23 <br />To: San Joaquin County <br />Department of Public Works <br />Michels Trenchless Inc <br />(Applicant Name) <br />1715 16th Street SE <br />(Mailing Address) <br />Salem, OR 97302 <br />(City, State, Zip Code) <br />(920) 539-3812 <br />(Area Code - Telephone Number) <br />dduhn@michels.us <br />(Email Address) <br />may <br />See Attached <br />OFFICE USE ONLY <br />JOB # 760034 REF # <br />APN 065-070-02 and 065-060-05 CR # <br />EXP.DATE <br />VALID 5/9/2023 TO 7/1/2023 DRIVEWAYS: <br />STREET Jack Tone Road <br />AREA Lodi QUAD NE <br />TYPE Jack Tone Rd. <br />FORMS SSANVV <br />NOTES Special Conditions <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the North -Bound side of Jack Tone Rd approximately 0.5 0feet/ QQ mile South <br />of E. Harney Lane , by performing the following work (description of work): <br />Cleaning and CIPP rehabilitation of culverts <br />Cleaning work will take one (1) day, and CIPP rehabilitation work will take two (2) days <br />Work is being preformed for San Joaquin County Flood Control and Water Conservation District under the defered maintenance program which is funded by Departmnet of Water Resources. <br />Work will commence on or after 5/9/23 for approximately 45 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 />DeAnn Duhn ��e"202305°03y1a0354 o7°oo 5/5/23 <br />Signature of Applicant - Title <br />Date <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the North -Bound side of Jack Tone Rd approximately 0.5 0feet/ QQ mile South <br />of E. Harney Lane , by performing the following work (description of work): <br />Cleaning and CIPP rehabilitation of culverts <br />Cleaning work will take one (1) day, and CIPP rehabilitation work will take two (2) days <br />Work is being preformed for San Joaquin County Flood Control and Water Conservation District under the defered maintenance program which is funded by Departmnet of Water Resources. <br />Work will commence on or after 5/9/23 for approximately 45 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 />DeAnn Duhn ��e"202305°03y1a0354 o7°oo 5/5/23 <br />Signature of Applicant - Title <br />Date <br />