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11/.16/2009 10:54 FAX 17077890414 ERI Petaluma a 002/002 <br /> c � v <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date November 11, 2 00 9 OFFICE USE ONLY <br /> To: San Joaquin County JOB# _//pppj REPO <br /> Department of Public Works APN CR# <br /> Environmental Resolutions EXP.DATE /*A10)D <br /> VALID O TO 0-1-010 DRIVEWAYS: <br /> (Applicant Name) STREET Hwy fq tOPD�ur59(� <br /> 601 North McDowell Blvd. AREA QUAD AOr <br /> TYPE LA&A24-5 <br /> (Mailing Address) FORMS Z <br /> Petaluma, CA 94954 <br /> NOTES <br /> (City,State,Zip Code) <br /> (707) 766.2000 <br /> (Area Code•Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See attached site map and photo for proposed groundwater monitoring well locations. <br /> The undersigned hereby applies for permission to excavate,canstnrct andlor otherwise encroach on County kfighway Right-of--Way on <br /> the East sldeof Hwy. 99 Frontage Road approximetety 10 feet/miie south <br /> of the intersection of E. wivayrna and Hay 99 Pxvntaue Rd- by performing the following work(description of work): <br /> Two groundwater monitoring wells will be drilled to approximately 140 feet <br /> using a mud rotary drilling rig. monitoring wells will be constructed of 2-inch <br /> diamgl;er Diff+ casing and sealed with a water tight seal <br /> Work will commence on or about before January 13, 2010 for approximately 5 days. <br /> =SignAp <br /> am th er of the respective property,or am qualified to represent the owner and agree to do the <br /> a tth Ute rules and regulations of San Joaquin County and subject to Inspection and approval. <br /> f ) (6 �9nt-Title Date <br /> Ew68enw�R,ggEwm�oaortn[MTene,lf•TDMeOe Pm0 <br />