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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 09/21/2023 <br />To: San Joaquin County <br />Department of Public Works <br />Geosyntec Consultants, Inc. <br />(Applicant Name) <br />3043 Gold Canal Drive, Suite 100 <br />(Mailing Address) <br />Rancho Cordova, California 95670 <br />(City, State, Zip Code) <br />(519) 400-4369 <br />(Area Code - Telephone Number) <br />waradhan@geosyntec.com <br />(Email Address) <br />may <br />See attached plans (Attachment 3) <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 South side of Lincoln Road ____ approximately _ 750 _ Q feet/ Qmile —st <br />of Gettysburg Place in San Joaquin County __ California_ by performing the following work (description of work): <br />Destroy six (6) groundwater monitoring wells under the supervision and approval of the Central Valley Regional Water Quality Control Board (CVRWQB) and <br />described by the Well Destruction Work Plan (Attachment 4) on Stanton Way, Cameron Way, McLellan Way, Sheridan Way, Calhoun Way, and Gettysburg place near W Benjamin <br />Holt Drive. Desiqn drawings with additional information are provided as Attachment 3 and include a traffic control plan for the required traffic control associated with the proposed work. <br />Work will commence on or after 10/30/2023 for approximately 2 business 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 />�p Principal Engineer <br />09/21/2023 <br />Signature of Applicant - Title <br />Date <br />