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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To: San Joaquin County <br />JOB # REF # <br />Department of Public Works APN CR # <br />EXP. DATE <br />VALID TO <br />DRIVEWAYS: <br />(Applicant Name)STREET * <br />AREA QUAD <br />* <br />TYPE * <br />(Mailing Address)FORMS <br />NOTES <br />(City, State, Zip Code) <br />(Area Code - Telephone Number) <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on ounty ighway ght-of-ay on <br />the ______________ side of ___________________________________ approximately ____________ feet/ mile _________ <br />of _______________________________________, ____________________, by performing the following work (description of work): <br />Work will commence on or after _____________________________________ for approximately ________________________ 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 />Signature of Applicant - Title Date <br />2/12/25 <br />Ahtna-Forgen JV <br />3100 Beacon Blvd. <br />West Sacramento, CA, 95691 <br />(916) 890-7042 <br />yama.ayobi@forgen.com <br />Please refer to Project Drawings/Plan, Haul Route, and Traffic Control Plan attached to this <br />application. <br />North West March Lane 6000 <br />Levee improvements <br />Levee Brookside Road <br />The Work includes improving approximately 6000ft/1Mile of levee by installing a seepage cutoff wall, re-grading the levee prism to a more stable condition, and installing rock slope protection <br />to prevent erosion along the dryland levee down Ten Mil Slough. The Work also includes but not limited to clearing, grubbing, and Stripping within the construction limits and areas designated <br />in the attached project plans. Approximately 50,000 Cubic yards of fill materials will be hauled to the construction site for levee embankment from the government provided borrow site. <br />The haul route from/to Borrow site to the construction site is also provided in project plans and Traffic Control plan. <br />3/15/15 800 <br />Yama Ayobi Digitally signed by Yama Ayobi <br />DN: C=US, E=yama.ayobi@forgen.com, O=Forgen, OU=QC Manager, CN=Yama Ayobi <br />Date: 2025.02.12 14:27:11-08'00'2/15/25