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PLEASE PRINT: <br />Date 2/12/25 <br />To: San Joaquin County <br />Department of Public Works <br />Ahtna-Forgen JV <br />3100 Beacon Blvd <br />(Applicant Name) <br />(Mailing Address) <br />APPLICATION FOR ENCROACHMENT PERMIT <br />West Sacramento, CA, 95691 <br />(City, State, Zip Code) <br />(916)890-7042 <br />(Area Code - Telephone Number) <br />yama ayobi@forgen corn <br />(Email Address) <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <br />Sketch (Detailed plans may be submitted) <br />Please refer to Project Drawings/Plan, Haul Route, and Traffic Control Plan attached to this <br />application. <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 West March Lane approximately 6000 Q feet/ Q mile eVee1mPfO0...lts <br />of Levee Brookside Road , by performing the following work (description of work): <br />The Work includes improving approximately 6000ft/1 Mile 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 />Work will commence on or after 3/15/15 for approximately 800 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 />Yama Ayobi °aa iouoi,,,, °;; o�000a��m o_Fasa�.°w°�M.�.ea,.—Y—A,- 2/15/25 <br />Signature of Applicant - Title Date <br />