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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 4/14/2014 OFFICE USE ONLY <br /> To: San Joaquin County JOB# oQ S REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE S/t <br /> Callan Yu VALID 5711114- TO DRIVEWAYS: <br /> (Applicant Name) STREET • t ,e <br /> AREA QUAD <br /> 4085 Nelson Avenue, Suite A TYPE o <br /> (Mailing Address) FORMS SS ,4 <br /> NOTES <br /> Concord, California, 94520 <br /> (City,State,Zip Code) <br /> 925-685-6300 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> SEE ATTACHED MAP <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the west side of_ Empire Tract Road approximately 7 miles feet/mile west <br /> of Interstate 5 and W. Eight Mile Road Stockton , by performing the following work(description of work): <br /> Drilling 8 geotechnical borings approximately 4 inches in diameter and 15 feet deep to collect soil samples. <br /> Boring Locations are approximately 5 feet from the edge of pavement <br /> Work will commence on or about May 2, 2014 for approximately 1 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 /> 61, e4 4/14/2014 <br /> Si ature of Ap !cant-Title - Date <br /> M:ICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (09/13) <br />