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0 0 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> OFFICE USE ONLY <br /> Date <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> DRIVEWAYS: <br /> VALID <br /> Callan Yu TO <br /> (Applicant Name) STREET <br /> AREA QUAD <br /> 2221 Commerce Avenue,Suite A-1 TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> Concord,California 94520 <br /> (City, State,Zip Code) <br /> (925)685-6300 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See attached map <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the east side of S.Bacon Island Road approximately 6.5 feet/mile east/north <br /> of Highway 4 and Bacon Island Road , Stockton , by performing the following work(description of work): <br /> Drilling 5 borings and 14 CPTs each approximately 4-inches in diameter at a distance approximately every 1,000 feet. <br /> September 12 and then again on September 26 forapproximately <br /> Work will commence on or about p4(9/12)days and then 5(9/26) 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 /> Signature o Applica t-Title I ate <br /> E:1PUB-SV.WNIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />