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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To: San Joaquin County JOB # REF # <br />Department of Public Works APN CR # <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />(Applicant Name) STREET * <br />AREA QUAD * <br /> TYPE * <br />(Mailing Address) FORMS <br />NOTES <br />(City, State, Zip Code) <br /> <br />(Area Code - Telephone Number) <br /> <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br /> <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br />the ______________ side of ___________________________________ approximately ___________________ feet/mile _________ <br />of _______________________________________, ____________________, by performing the following work (description of work): <br /> <br /> <br /> <br />Work will commence on or after ___________________________________ for approximately ________________________ 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 /> <br />Signature of Applicant - Title Date <br />Y:\FORMS & TEMPLATES\ENCROACHMENT PERMIT APPLICATION.doc (08/08) <br />December 17, 2020 <br />188 Frank West Circle, Suite I <br />Stockton, CA 95206 <br />(209) 513-7634 <br />lcastle@condorearth.com <br />Please see attached figure. <br />south Fairoaks Road, Tracy, California, 15 south <br />Fairoaks Road Tracy, California <br />1December 25, 2020 <br />Luke Castle- Staff Geologist December 15, 2020 <br />Luke Castle - Condor Earth <br />Condor Earth will be supervising Moorman's Water Systems during the destruction of groundwater monitoring well MW-7, which is <br />approximately 15 ft south of the roadway in front of the residence located at 8780 Fairoaks Road in Tracy, California. Groundwater <br />monitoring well MW-7 will be destroyed by over drilling the well and annular space (Apprximately 12" diameter) and backfilling with <br />cement grout slurry. The upper 2 ft will be backfilled with native soil to match existing surrounding surface conditions.