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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: V5- t n't 0�S <br /> Date January 31,2014 OFFICE USE ONLY <br /> To: San Joaquin County JOB# ( (LUQ S REF# <br /> Department of Public Works APN CR# <br /> tpir rri Ne h m Lor EXP.DATE _ <br /> Kjeldsen, Sinnock&Neudeck, Inc. VALID TO _ DRIVEWAYS: <br /> (Applicant Name) STREET = fi <br /> � _ <br /> AREA �'t&,' QUAD — <br /> 711 N. Pershing Avenue TYPE c <br /> (Mailing Address) FORMS _ <br /> NOTES <br /> Stockton, California,95203 <br /> (City,State,Zip Code) <br /> (209)946-0268 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See Attached. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the north&south side of Eight Mile Road at Honker Cut approximately 500' feet/mile <br /> of right of way along the bridge at Honker Cut _,by performing the following work(description of work): <br /> KSN will be performing design surveys of the the existing bridge to support the bridge deck rehabilitation. KSN is a sub- <br /> consultant on the design team working for San Joaquin County Public Works-Bridge Division. Traffic control will be <br /> necessary due to the narrow roadway along the bridge. <br /> Work will commence on or about February 10th for approximately 2 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 /> \\/ Kris F. Nehmer, Land Surveying Manager <br /> V f A� <br /> Signature of Applicant-Title T—��— Date <br /> M.ICENTRALSERVICE&CLBUC,ALIPUBSV.WHWASTER.PSIENCROACHMENTPERAUTPPPLICATIOtLDOC(09113) <br />