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PLEASE PRINT: <br />Date November 20, 2019 <br />To: San Joaquin County <br />Department of Public Works <br />Mountain Cascade Inc. <br />(Applicant Name) <br />P.O. Box 5050 <br />(Mailing Address) <br />APPLICATION FOR ENCROACHMENT PERMIT <br />Livermore, Ca, 94551 <br />(City, State, Zip Code) <br />925-373-8370 <br />(Area Code -Telephone Number) <br />HowardR@MountainCascade-com <br />(Email Address) <br />JOB# <br />APN <br />EXP, DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />760530 REF# i`-(QD3(01E7 <br />CR # <br />17131/1 q <br />11 /"/1 cl TO 1�1/3 I// DRIVEWAYS: <br />11AVAW%+r5 Re C* -d <br />Trac LQUAD <br />Tr k�w4 <br />SSiww, (><211 ,?1 ench (0+ <br />Sketch (Detailed plans maybe submitted) <br />Detailed plans submitted via E-mail on November 4, 2019 to Jayna Rutz. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />tHr, East and West side of S Lammers Road approximately 1 375 fee►ite south <br />of Capital Park Drive/Jaguar Run by performing the following work (description of work): <br />Installation ofpproxim tely 2,160 F of 24" durtile iron reryrlPd water main,-apPrnximateIy 16 1 F of 16" ductile iron <br />recycled water main and associated surface and pavement restoration. <br />Work will commence on or after November 17 2019 for approximately <br />Gays. <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 />� Howard Rei; <br />re of Applicant -Title <br />Y:ffCRMS L TEhIPLATESIENCROACHAIENT PERM APPLICATION.dac (08108) <br />Sr. Project Manager November 20 2019 <br />Date <br />