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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 1/30/15 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 110002 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE -- <br /> Allegiance Group, LLC VALID -3-4-15 TO 4 Is- jS DRIVEWAYS: <br /> (Applicant Name) STREET Yot+4p[C/fjayl fke T <br /> AREA QUAD _S <br /> 1500 D Street TYPE 6o rP <br /> (Mailing Address) FORMS S w11'92-4) <br /> NOTES <br /> Vancouver, WA 98663 <br /> (City,State,Zip Code) <br /> (360) 690-4331 <br /> (Area Code-Telephone Number) <br /> (e 30 - qgol <br /> Sketch(Detailed plans may be submitted) <br /> b0,#-bot , /00i-fvP ooJ Ai I tel f a nc e y roup OM <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 side of approximately feettmile <br /> Of by performing the following work(description of work): <br /> Drill and sample a total of FOUR 8-inch diameter soil/geotechnical borings in the locations <br /> indicated on the attached map and table. Backfill and restore as required by the governing <br /> agency. Please note: the four borings in San Joaquin County jurisdiction are PBS-3, 4 5 and 6; <br /> PBS-1 and 2 are within the City of Stockton city limits. <br /> Work will commence on or about 2/21/15, or 1 week after for approximately 4 days. <br /> receipt of permits, whichever is sooner <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 /> 0 cJ&yr1/30/15 <br /> Signatur of Applicant-Title Date <br /> M:ICENTRALSERVICEMERICAL\PUB-SV.WKNIASTEPPSENCROACNMENTPERMRAPPI.ICATION.DOC (09113) <br />