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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 8/21/23 <br />To: San Joaquin County <br />Department of Public Works <br />Lauren Herbert <br />(Applicant Name) <br />3160 Gold Valley Drive, Suite #800 <br />(Mailing Address) <br />Rancho Cordova, California, 95742 <br />(City, State, Zip Code) <br />(916) 805-6227 <br />(Area Code - Telephone Number) <br />herbert@geoconinc.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />610127 REF # <br />CR # <br />9/4/2023 TO DRIVEWAYS: <br />Multi -Locations (see attached Maps) <br />Stockton QUAD LV <br />Bores <br />SS/VWV, Trench Cut Policy <br />Special Conditions <br />(See attached MUTD plans and Site Plan documents) <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 W Greeley Way, McClellan Way, Sheridan Way, and Douglas Rd approximately 300-1400 _ IQ feet/ Q mile north and south <br />of West Benjamin Holt Drive Stockton , by performing the following work (description of work): <br />We will be drilling four, six -inch -diameter, vertical soil borings to a depth of approximately 15 feet below existing ground surface for our geotechnical investigation. Upon completion of our drilling, <br />the borings will be backfilled with neat cement grout in accordance with San Joaquin County Environmental Health requirements. <br />Each soil boring is anticipated to take one hour total to drill and backfill per county requirements. <br />Work will commence on or after 9/4/23 for approximately <1 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 />Z"ott- - Senior Staff Engineer <br />Signature of Applicant - Title <br />8/21/23 <br />Date <br />