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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 5/27/2014 OFFICE USE ONLY <br /> To; San Joaquin County JOB# _Z?(�%(1 a' REF# _ <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Johnathan Wright VALID "7—16- 14 TO 0- /S- (¢ DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA -Aa0a2 (-;,1 QUAD ,t W <br /> 4030 S Land Park Drive,Suite.C TYPE e IV' <br /> ' <br /> (Mailing Address) FORMS ('VW W R Z <br /> NOTES <br /> Sacramento,Ca,95822 <br /> (City,State,Zip Code) <br /> (916)455-4225 <br /> (Area Code-T elephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Please see attached documents <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 Cotta Road approximately 200'to 400' feet/mile East <br /> of Intersection W Cotta Road&N Guard Road ,by performing the following work(description of work): <br /> Performing a geotechnical investigation near the bridge on W Cotta Road located—300'East of the above intersection. This investigation will involve drilling two <br /> borings on either side of the bridge. The boring on the East side of the bridge will be in the street and require a one-lane closure. The second boring,on the West <br /> side of the bridge,will be performed in the shoulder and will require a partial lane closure. Depending on utility locations,this boring may be performed in the <br /> street,w is will also require a one-lane closure.A map with the boring locations,as well as traffic control iagrams,are attacried to tnis clocument, <br /> Work will commence on or about May 29 to June 13 _for approximately Two 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 /> 1-2 <br /> Signature of Applicant-Title Date <br /> V <br /> MICENFAPLffRJ10E51ClEAICN.Wl135Y.N1fdW-FJtPS1etCRC?L-0AFM FFA4R Mft1GTON.DOC(OJ?� <br />