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LH;SF •TEL No . a1 � 'L„ , <br /> 1 93jjHug 03190 14 :28 F' . 03 <br /> y <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> Date_ Y_! 12 �o <br /> To the San Joaquin County <br /> Highway Department <br /> Gentlemen: <br /> The undersigned hereby applies for permiseion to excavate, construct and/or otherwise encroach on <br /> County Highway right of way by performing the following work: <br /> Installation of a Monitorin Well on a county sidewalk <br /> Applicant will describe here fully what he wishes to do,using reverse side if necessary? <br /> A 4 1 /2-inch diameter monitoring well will be installed to a depth of <br /> EG feet Pl th encl stru d t i <br /> dace for sketch / / tbmlt detailed Diane if available. <br /> Iq <br /> T <br /> C'yf'.�+-y,5 b t.c•'"� -rra��;r✓�Y�°h5 Q ' <br /> � � ll' C•:ww <br /> On CountyHiehway S: ctewafk - Loc�atf;on Ff, <br /> Gettysburg Place approximately 40 feet north of Benjamin Holt in the west sidewalk, <br /> (Applicturt will state here accurately the location of the wont he deeires to do) <br /> and ogrees to do the work in accordance with your rules and regulations and subject to your inspection <br /> and approval, <br /> Signature of t <br /> Phone . cumber <br /> 363 - 2 ^� s% ST�F nl <br /> ost Mice Address S/ �aJCrfC J Gtr <br /> Pewit issued; <br /> • rK r. roiw <br />