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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> s - 2396 <br /> Date August 1, 2014 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> Woodbridge Irrigation District EXP.DATE 10-7-0 - 14 <br /> c/o Anders Christesen VALID �L— TO -ZQ-( DRIVEWAYS: <br /> (Applicant Name) STREET L niAl e 5u C <br /> AREA Lod r QUAD A_ <br /> 18750 N. Lower Sacramento Rd TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> Woodbridge, CA ,95258 <br /> (City,State,Zip Code) <br /> (209) 625-8438 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Plans Are Attached hereto <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> theE-W & Acrosssid&of Lower Sacramento Rd approximately 1300 ft feet/mile south <br /> of the intersection of Mettler Rd & Lower Sac by performing the following work(description of work): <br /> To install a 48" RCP under Lower Sacramento Rd as part of the Pixley Lateral. The <br /> work is being scheduled in phases in order to place a portion of the pipe (Phase 1) in <br /> advance of the planned Tower Sacramentn Rd Widening project The second phase will take <br /> at a--later date and coordinated with the 2nd phase of the Lowesr Sacramento Rd Widening <br /> project as worked out with the County Design Section. <br /> Work will commence on or about ,o„et14 9nL4 for approximately 5-7 days. <br /> 2S <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 /> M ICENTRALSERNCESICLEWCALIPUR-SV.WKWASTER.PSIENCROACHMENT PERMIT APPLICATION DOC (09113) <br />