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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASEPRINT: <br />OFFICE USE ONLY <br />JOB#,I 00 (J ~REF# <br />APN CR# <br />EXP.DATE )-17-Ie. <br />VALID 7 ~1~~~e;O ij7-1(,DRIVEWAYS: <br />STREET • <br />AREA (rcfiI/em QUAD Ie • <br />TYPE TeeM/'• <br />FORMS "'41 W R)II ¥PftM fpmqlNOTES <br />To:San JoaquinCounty <br />Departmentof Public Works <br />City of Escalon <br />(Applicant Name) <br />2060 McHenry Avenue <br />(Mailing Address) <br />Escalon,CA 95320 <br />(City,State,Zip COde) <br />(209)691-7422 <br />(Area Code -Telephone Number) <br />Date January 13,2016 <br />Sketch (Detailed plansmaybe submitled) <br />See attached plans. <br />The undersignedherebyappliesfor permission10 excavate,constructand/or otherwiseencroachonCounty HighwayRight-of-WayontheleftandrightsideofRiverRoadIapproximately80feeVmile_ <br />of 24"sewer line ,loj I ,by performingthe followingwork (descriptionof work): <br />The City of Escalon will excavale a section of failed:y.1"sewer pipe that runs under River Road.The localion of the <br />excavalion will be along lhe easl side of the abandoned railroad tracks (GPS:37.759028,-120.002942).The Cily will <br />re lace the existin 'sewer i e with 24"SDR 26 PVC i e.The Cil will then backfill com act and trench atch er <br />Sa Joa uin Co n Public Works "T ical Trench Backfill"Delail 0 R-9.----~M.Work willcommenceon or about 1/26(/f,for approximately 2-days. <br />I,the undersigned,certifythat t am the owner of the respeclive property,oram qualified 10 representthe owner and agreeto do the <br />work describedabove in ccor ance with the rulesand regulationsof SanJoaquin Countyandsubject to inspectionand approval.