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4TATE OF CALIFORNIA• DEPANT OF TRANSPORTATION STANDARD ENCROARMENT PERMIT APPLICATION Front TR-Glop (REV 10/93) FOR CALTRANS USE PERMIT NO . I'ermLsslon IN requested to encroach on the State Highwav Right of Wav as follows (Compiete all Items NA if rix aryixcacle) Application is not complete until all r uirt d attachmLnts are includLd DISTlCOdRT&PM p� I C-1 - S ,� - 6 - I LOCATION CITY 2 COUNTY 3 ROUTE SIMPLEX STAMP e� I C ' r '_ I , 4 POST MILE 6 APPLICATION DATE I 6 d0(D�D1RESS OR STREET NAME 7 CROSS STREET(D)stancs and(*rec7)o from re). r-r r ► I, ' � : {j 4'e 8 PORTION RIGHT OF WAY / DATE OF SIMPLEX STAMP 7--) tw N b 9 WORT{TO BE PERFORMED BY 10 ST START DATE 1 EST COMPLETION DATE 12 EST COST IN STATE RMr ❑OWN FORCES b CONTRACTOR 12/15/94 12/15/94 $3 500 13 MAX DEPTH 114 AVG DEPTH 15 AVG WIDTH 16 LENGTH 17 SURFACE TYPE EXCAVATION N/A N A N /A 18 TYPE 1 g DIAMETER 20 VOLTAGE!KPA 21 PRODUCT PIPES N/A N A 22 ALLY DESCRIBE WORK WITHIN STATE FUW Attach complete plans(minimum 5 sets folded 21 59 centimeter X 27 34 centfineter(B r/2X t F }) specs talcs maps etc df applfrable See attachment 1 23 Is any work being done on applicant a property? Ongoing groundwater m o n t 1 o r 1 R g ® YES 0 NO (!f*YES',bneRy describe and attach sets and grading plans) and s o i l /groundwater treatment 24 Is a city,county,or other agency involved 1n the environmental approval?County Wel l perms t requ 1 red (to be Data i n 0 YES (Check documentainn type and Artach approved copy) ❑ EXEMPT ❑ ND ❑EIR ❑ NO (Check the category badow which daar obda the protect) ❑ SURVEY ❑ FENCE ❑ PAAADES CELEBRATIONS ❑ MAINTENANCE OF EXISTING LANDSCAPING ❑ FLAGS SIGNS BANNERS ❑ SINGLE FAMILY DWELLING ❑ COMMUNITY ANTENNA TV SYSTEM DECORATIONS DRIVEWAY ❑ REGULATORY WARNING ❑ TEMPORARY SIGNALS ❑ REMOVAL REPLACEMENT OF ❑ EROSION CONTROL INFORMATION SIGNS DISTINCTIVE ROADWAY MARKINGS ❑ AGRICULTURAL APPROACH ❑ MODIFICATION OF TRAFFIC ❑ PUBLIC UTILITY MODIFICATIONS CONTROL SYSTEMS EXTENSIONS HOOKUPS ❑ DITCH PAVING ❑ MAINTENANCE RECONSTRUCTION OR RESURFACING OF A DRIVEWAY OR ROAD ❑ MOVIE TV FILMING ❑ SIOEWALKIGUTTERS ❑ MAILBOX APPROACH ❑ NONE of THE ABOVE fit protea carrot be dawnbed in above oatepona;reau"appiecailon Part B from rhe Permt Offloa) The undersigned agrees and understands that a permit can be denied or a bond required for non-payment of prior or present permit fees, and that the work will be done in accordance with Caltrans rules and regulations subject to inspection and approval. 25 ORGANIZATION OR APPLICANT NAME(Pent or Type) 26 BUSINESS PHONE ARCO Products Company 415 571 -2468 . _ 27 ARCHITECT ENGINEER OR PROJECT MANAGER NAME(Print or Type) - 28 BUSINESS PHONE Kyle Christie 415 571 -246,1 29 BUSINESS ADDRESS(iitclud8 CRyand Zp Code) P O Box 5811 , San Mateo CA 94402 30 AU ZED 1 31 PRINT OR TYPE NAME 32 TITLE 33.DATE Kyle Christie � Environ Engi neer [_1j1qLj,1 FM 1403 M