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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2/17/23 <br />To: San Joaquin County <br />Department of Public Works <br />ATC Group Services LLC dba Atlas Technical <br />(Applicant Name) <br />1117 Lone Palm Avenue, Suite 201 B <br />(Mailing Address) <br />Modesto, CA, 95351 <br />(City, State, Zip Code) <br />(209) 579-2221 <br />(Area Code - Telephone Number) <br />john.sellman@oneatlas.com <br />(Email Address) <br />may <br />See highlights on attached plans <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP.DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County highway right-of-way on <br />the north and south side of E. Main St. east of Oro Ave. also 953 Adelbert Ave. approximately Q feet/ Q mile <br />of _ , by performing the following work (description of work): <br />Remove well boxes and destroy groundwater monitoring wells according to San Joaquin County <br />Environmental Health Department standards, located on the north and south sides of East Main <br />Street and Oro Avenue, north and south sides of East Main Street and Adelbert Avenue and south <br />side of East Main Street and South Sinclair Avenue. Also near 953 Adelbert Avenue. <br />Resurface street or sidewalk according to County standards. <br />Work will commence on or after 4/1/23 for approximately 14 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 />John Sellman <br />Signature of Applicant - Title <br />Date <br />