Laserfiche WebLink
h <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> E_ PR=NT_ <br /> Date 5/20/04 OFFICR USE ONLY <br /> To San Joaquin County JOB _ 114z257 - - REF # <br /> Department of Public Works , APN _ CR # <br /> EXP. DATE 7 - IS O'/ <br /> WESTERN GEO-ENGINEERS . _ _ _ _ VALID G • O Y To _ 7- IS-1 ,6Z DRIvSWAYs <br /> (ApplJcarft Name) STREET G00A11My C-L-OAr <br /> AREA 5'TY� QUADCom. <br /> 1386 E. Beamer Stmet TYPE •��NI Tape��►! et� <br /> (Mailing Address) FORMS 73 w'i--l. .e- z - T - <br /> NOTE <br /> Woodland CA <br /> (City, State, Zip Code) T <br /> (530) 668-5344 --- <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> See Attached Figures for location of Groundwater Monitoring <br /> Wells MW9A & MW9B <br /> F <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the South side of <br /> Cc miLr y Club Blvd , - - approximately _133 -&- l -7,6 _ - fee /mile West <br /> of the SW corner of Mi ssi on StrPpt_ & ,C by performing the <br /> following work (description of work) Using a r-ia pq,ii pped ,.7,t1, <br /> hollow stem '�aers dr w0 " <br /> wells (MW A'& MW B to doptLs 8 a d 2 <br /> well die rams for <br /> observed bv the SUCEHD <br /> Work will commence on or about _ _June 22_2_Q04 for approximately <br /> 2 days "_` <br /> 1, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval <br /> Si ure of Applicant - title Data ^� <br /> �''�� pslFsaSp�L {6f 30/00) <br />