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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 14 October 2015 OFFICE USE ONLY <br /> To: San Joaquin County JOB# A,—i ^V�Z REF# <br /> Department of Public Works APN CR# <br /> EXP.DATEZQZ <br /> Shawn Leyva C(24w ,�r�a AtT-�' _2.2e,, `' TO s_ DRIVEWAYS: <br /> (Applicant Name) STREET Q <br /> AREA QUAD pp!� <br /> 4030 S Land Park Drive, Suite C TYPE <br /> YY� <br /> (Mailing Address) FORMS C' -L { irc cX <br /> NOTES <br /> Sacramento Ca 95822 <br /> (City,State,Zip Code) <br /> (916) 455 4225 <br /> (Area Code-Telephone 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/South side of N. Wimer Rd approximately 0.5 miles feet/mile East <br /> of intersection Wimer Rd and N. Wimer Rd , by performing the following work(description of work): <br /> Performing a geotechnical investigation near the bridge on N Wimer Rd. This investigation will involve <br /> drilling two boring on either side of the bridge. The boring on the east side will be in the street and <br /> require a one-lane closure. The second boring, on the west side of the bridge, will be performed in the <br /> shoulder and will require a partial lane closure. Depending on utility locations, this boring may be <br /> performed in the street. A map with boring locations and traffic control diagram are attached. <br /> Work will commence on or about 20 Oct 2015 for approximately 1 - 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 /> 15 Oct 2015 <br /> Signature of licant-Title Date <br /> EE:IPUB-SV.W@MASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br />