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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date August 25, 2009 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE !Q./•Q _ <br /> Ross Island Sand & Gravel Co. VALID 9.10 TO f0•/• DRIVEWAYS: <br /> (Applicant Name) STREET A)unn�jLC jof ,G�v, <br /> AREA 1::;- 6779 QUAD <br /> P.O. Box 82249 TYPE hA)4 <br /> (Mailing Address) FORMS <br /> NOTES <br /> Portland, OR 97282-0249tJ <br /> / -at Axww_ <br /> (City, State,Zip Code) D `` P!1~L�� <br /> ( 503 ) 314-3348 or (209 ) 933-0609 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> See Attached Drawings <br /> Trench Cut Windmill cove for the temporary installation of a 20"O.D. <br /> dredge discharge pipeline. Dredging under authority of the <br /> U.S. Army Corps of Engineers Contract No. W91239-09-D-0026 TO#1 . <br /> Levee Encroachment permit already held from Reclamation District 684 <br /> (Lower Roberts Island) for the dredging work. <br /> Ross Island Sand & Gravel Co. - Randall H. Steed ( 503) 314-3348 - Cel <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the across sW:6f Windmill Cove Road approximately 930 linear feetkta East <br /> of intersection w/ N. Holt Rd,. Stockton, CA , by performing the following work(description of work): <br /> Saw cut road where previously patched from our dredging operation in <br /> 2006. Excavate road base and fill Install HDPE dredge_ pipe CoverpipP <br /> per county specification for typical trench back-fill- S.- Cold-patch roado <br /> Dredging roughly 2 weeks before removal, fill, compaction, and Hot-patch <br /> Windmill cove rd. to prior condition. <br /> Work will commence on or about September 10, 2009 for approximately 1 day each hasp 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 /> 3{ S <br /> <...h.. <br /> August 25, 2009 <br /> Signature of Applicant-Title Randall H. Steed Date <br /> f'FORMS L TEMPLATESSENCAOACHMENT PERMIT APPLICATION,doc!089DE) Dredge Project Manager <br />