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U610712011 09:45 Advanced GeoEnviromental Inc. <br /> (FAi()209 4671118 P.0021002 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT- <br /> Date 06iQ7/2011 <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN <br /> _ CR# <br /> Advanced aeoEnvironmeuta]. Inc. EXP'DATE —' t3 <br /> VALID —6-2Uti TO _20 DRIVEWAYS: <br /> (Applicant Name) STREET VGA C <br /> AREAS QUAD �_ <br /> 837 Shaw Road TYPE <br /> (Mailing Address) FORMS <br /> Stockton, Ca, 95215 NOTES <br /> (City,State,Zip Code) <br /> 1-209-467-1006 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) see Attached Site Flan <br /> The undersigned hereby applies for permission to <br /> the various Side of various excavate,construct andlor otherwise encroach on County Highway Right-of-Way on <br /> approximate) Various ofyariouA Y (description <br /> varioe <br /> advancement of 5 vertical borings (P-17, P-18, P-19, P-20 and'P Performing <br /> ert or ingtached the following <br /> work(d e�Caption o work): <br /> ground water a�a►mgies at 35-5o feee and 75 to Bo leet below and <br /> P-21 <br /> 1 of grab <br /> grade. <br /> Work will commence on or about Between 20-24 June 2011 <br /> for approximately a 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 /> -...Qn:Z: <br /> `-" `-�.� 06/7/2011 <br /> Signature of Applicarn-Tine Date <br />