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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10/14/2019 <br />To: San Joaquin County <br />Department of Public Works <br />Geocon Consultants, Inc. <br />(Applicant Name) <br />3160 Gold Valley Drive, Suite 800 <br />(Mailing Address) <br />Rancho Cordova, CA 95742 <br />(City, State, Zip Code) <br />916-852-9118 <br />(Area Code -Telephone Number) <br />fernandez@geoconinc.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />(see attached) <br />The undersigned hereby applies for permission to excavate, construct antl/or otherwise encroach on County Highway Right -of - <br />Way on the East side of Pezzi Road at 3 locations approximately 0_9 miles north of Comstock Road, by performing the following <br />work (description of work): <br />Geotechnical borings for proposed bridge <br />and roadway realignment <br />Work will commence on or after 10/22!2019 for approximately <br />days. I, <br />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 - <br />Y:1F0Rhl ; 8 TEIdPLATESIENCROACHMENT PERMIT APPLICATIOIJ.dor. 100106) <br />ra <br />10/14/2019 <br />Date <br />OFFICE USE ONLY <br />JOB # <br />227 <br />REF # <br />APN <br />CR # <br />EXP. DATE <br />1 D,3a @ fVI1 <br />VALID <br />STREET <br />10%2e%26 <br />TES I <br />TO 10t30t t 2011. DRIVEWAYS: <br />AREA <br />QUAD <br />TYPE <br />FORMS <br />61V M� <br />NOTES <br />1 <br />G' <br />LM <br />The undersigned hereby applies for permission to excavate, construct antl/or otherwise encroach on County Highway Right -of - <br />Way on the East side of Pezzi Road at 3 locations approximately 0_9 miles north of Comstock Road, by performing the following <br />work (description of work): <br />Geotechnical borings for proposed bridge <br />and roadway realignment <br />Work will commence on or after 10/22!2019 for approximately <br />days. I, <br />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 - <br />Y:1F0Rhl ; 8 TEIdPLATESIENCROACHMENT PERMIT APPLICATIOIJ.dor. 100106) <br />ra <br />10/14/2019 <br />Date <br />