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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 5/13/24 <br />To: San Joaquin County <br />Department of Public Works <br />LINDEN COUNTY WATER DISTRICT <br />(Applicant Name) <br />P.O. BOX 595 <br />(Mailing Address) <br />LINDEN, CA 95236 <br />(City, State, Zip Code) <br />(209)887-3216 <br />(Area Code - Telephone Number) <br />jvlindencwd@verizon.net <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE x <br />FORMS <br />NOTES <br />SEE ATTACHED PROJECT PLAN SHEETS C1 THRU C11. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the various side of the following streets approximately 1700 Q feet] (D mile 0.32 <br />of asphalt concrete by performing the following work (description of work): <br />replacing water mains on Front & Ione Street as attached on project plan Sheets C1 thru C11. <br />Work will commence on or after <br />I, the undersigned, certify <br />work described above in a <br />5/27124 <br />for approximately <br />180 <br />days. <br />am the owner of tl�p respective property, or am qualified to represent the owner and agree to do the <br />dance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />nature of AppMWnt - Title <br />Date <br />