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APPLICATION FOR ENCROACHMENT PERI\IIIT <br />PLEASE PRINT: <br />Dale 05/05/16 <br />To:San Joaquin County <br />Departmentof PublicWorks <br />Arcadis U.S.,Inc.(contact:Megan Smoley) <br />(Applicant Name) <br />101 Creel<side Ridge Court,Suite 200 <br />(Mailing Address) <br />Roseville,CA 95678 <br />(City,State,Zip Code) <br />626.590.1502 <br />(Area Code.Telephone Number) <br />Sketch (Detailedplans maybe submitted) <br />See attached plan <br />I JOB II <br />OFFICE USE ONLY <br />ILOOOY REF ;; <br />APN CR# <br />EXP.DATE '1 (-!{ <br />VALID 19 ?/r#TO 9-1-I L DRIVEWAYS:,STREET ~.e~ <br />AREA \V,d (Y QUA S 14/• <br />TYPE ~~~;(779FORMS~: <br />NOTES <br />I <br />The undersignedherebyappliesfor permissionto excavate,constructand/orotherwiseencroachon CountyHighway Right-of-WayonthenorthsidaofSouthPattersonPassRoadapproximately95to170~Jmile west <br />of the Interstate 580 south-bound off-ramp ,by performingthe followingwork (descriptionof work): <br />Repair existing damaged vaults for MVV-7 and S-3.See attached plan for details. <br />Work will commenceon or about upon permit application approval for approximately one days. <br />I,the undersigned,certify that I amthe ownerof the respectiveproperty,or am qualifiedto representthe ownerand agreeto do the <br />work describedabove in accordancewith the rules and regulationsof San Joaquin County and subject to inspectionand approval. <br />05/05/16 <br />Date